Individual
DR. BRENT DONALD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
30 N 1900 E, ROOM 4A100 SOM, SALT LAKE CITY, UT 84132-0002
(801) 585-7676
(801) 581-7735
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 408-8112
(801) 408-6830
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4984011-1205
UT
207RC0000X
Cardiovascular Disease Physician
Primary
4984011-1205
UT
Other
Enumeration date
07/07/2006
Last updated
12/20/2021
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