Individual
JILL MALLORY FADAL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1389 CENTER DR STE 200, PARK CITY, UT 84098-7660
(970) 484-4757
(970) 484-4759
Mailing address
2008 CARIBOU DR, FORT COLLINS, CO 80525-4325
(970) 484-4757
(970) 484-4759
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10964555-1205
UT
2085R0202X
Diagnostic Radiology Physician
15751A
WY
2085R0202X
Diagnostic Radiology Physician
35561
NE
2085R0202X
Diagnostic Radiology Physician
DR.0070579
CO
Other
Enumeration date
03/31/2015
Last updated
03/04/2024
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