Brandon Maray Wilson, D.O

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4976 Issued in OK

Practice address

1120 S Utica Ave
Suite G100
Tulsa, OK 74104-4012

Phone

(918) 392-0175

Fax

(918) 392-0176

NPI assigned

Sep 10, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Interoperability endpoints

• Direct secure messaging: brandon.wilson.p1@direct.smc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stillwater Medical Center Authority

  • General Acute Care Hospital
  • Stillwater, OK
  • NPI 1164494027
  NPD (past)

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1083921191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE G100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-392-0175",
            "fax_number": "918-392-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 S UTICA AVE",
            "address_2": "SUITE G100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044012",
            "telephone_number": "918-392-0175",
            "fax_number": "918-392-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRANDON",
        "middle_name": "MARAY",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-10",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "OK",
            "license": "4976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200304180A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• April Wilson
• Ashlee Wilson
• Ashley Wilson
• Ashley Nicole Wilson
• Aubree Wilson
• Braven Wilson, DPH
• Brianna Lauren Christine Wilson
• Brittany Nicole Wilson
• Brook Ashley Wilson, PA
• Carol Ann Wilson, P.T.

• Obstetrics & Gynecology Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Obstetrics & Gynecology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.