Individual
JASON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2211 LOMAS BLVD NE, 2ND AMBULATORY CARE CTR - DEPT OF SURGERY, ALBUQUERQUE, NM 87131-0001
(505) 272-5505
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2001-336
NM
2088P0231X
Pediatric Urology Physician
Primary
2001336
NM
Other
Enumeration date
08/02/2006
Last updated
05/20/2025
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