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Organization

G SAM WILSON MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
G. SAM WILSON M.D. (PROVIDER)
(801) 298-9100
Entity
Organization

Contact information

Practice address
440 MEDICAL DR, BOUNTIFUL, UT 84010-4950
(801) 298-9100
(801) 298-2238
Mailing address
440 MEDICAL DR, BOUNTIFUL, UT 84010-4950
(801) 298-9100
(801) 298-2238

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1754341205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
5287442330001
UT
Enumeration date
03/28/2007
Last updated
11/19/2007
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