Individual
MR. ANDREW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3741 W 12600 S, RIVERTON, UT 84065-7215
(801) 727-2056
(770) 701-6676
Mailing address
PO BOX 3570, SALT LAKE CITY, UT 84110-3570
(801) 727-2056
(303) 780-0787
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
12994458-1204
UT
207L00000X
Anesthesiology Physician
DR.0065653
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/20/2017
Last updated
11/30/2022
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