Individual
CARL THAYNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1034 NORTH 500 WEST, UTAH VALLEY REGIONAL MEDICAL CENTER, PROVO, UT 84604
(801) 507-5248
(801) 733-5618
Mailing address
3340 NORTH CENTER ST, #800, LEHI, UT 84043-7406
(801) 990-1911
(801) 990-1912
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
88-179937-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002089788
—
NV
01
—
107005544101
IHC
UT
05
—
119214100
—
WY
01
—
1502954
UMWA
UT
01
—
2090168
UNITED HEALTHCARE
UT
01
—
37038
DESERET MUTUAL
UT
01
—
37831
PEHP
UT
01
—
53282
HEALTHY U
UT
05
—
768046
—
AZ
05
—
806095300
—
ID
01
—
8597445
WORKERS COMP
UT
01
—
870545614WI1
EDUCATORS MUTUAL
UT
01
—
QM0000075886
ALTIUS
UT
01
—
TPRA07712
MOLINA
UT
Enumeration date
10/03/2006
Last updated
10/15/2012
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