Active NPI
David James Wilson, D.O.
- Surgery Physician
- Tahlequah, OK
National Provider Identifier
1427168566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 01325
- Practice address
- 100 S Bliss Ave
Tahlequah, OK 74464-2512 - Phone
- (918) 458-3100
- Fax
- (918) 458-3511
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 01325 | IA | Primary |
| Surgery Physician | 208600000X | 2003 | AZ |
Addresses
Primary practice location
100 S Bliss Ave
Tahlequah, OK 74464-2512
Mailing address
27 Gary CT
Lake Ozark, MO 65049-6716
Phone (573) 365-7241
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100174400A | Medicaid | OK | |
| 150600003 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01325 | IA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295913600000",
"number": "1427168566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 GARY CT",
"city": "LAKE OZARK",
"state": "MO",
"postal_code": "650496716",
"telephone_number": "573-365-7241",
"fax_number": "918-458-3511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 S BLISS AVE",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744642512",
"telephone_number": "918-458-3100",
"fax_number": "918-458-3511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "DAVID",
"middle_name": "JAMES",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2011-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IA",
"license": "01325",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "AZ",
"license": "2003",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100174400A",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "150600003",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.