John W. Wilson, MD, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A049745 Issued in CA

Legal business name

JOHN W. WILSON, MD, INC.

Practice address

1800 Sullivan Ave
Room 503
Daly City, CA 94015-2228

Phone

(650) 994-9090

Fax

(650) 994-9093

NPI assigned

Oct 12, 2006

Last updated

Apr 3, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Wells Wilson, M.D.

Title

Owner

Phone

(650) 994-9090

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1023107109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2248",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940172248",
            "telephone_number": "650-994-9090",
            "fax_number": "650-994-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 SULLIVAN AVE",
            "address_2": "ROOM 503",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940152228",
            "telephone_number": "650-994-9090",
            "fax_number": "650-994-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN W. WILSON, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WELLS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-994-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A049745",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORPORATION #",
            "identifier": "2411141",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Daly City, CA
• Providers in Daly City, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.