Active NPI
Eric Eugene Wilson, L.M.T.
- Specialist
- Clearwater, FL
National Provider Identifier
1568687580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA13827
- Practice address
- 621 Lakeview Rd
Suite B
Clearwater, FL 33756-3364 - Phone
- (727) 461-9808
- Fax
- (727) 461-9809
- NPI assigned
- Apr 16, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA13827 | FL | Primary |
Addresses
Primary practice location
621 Lakeview Rd
Suite B
Clearwater, FL 33756-3364
Mailing address
621 Lakeview Rd
Suite B
Clearwater, FL 33756-3364
Phone (727) 461-9808
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA13827 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568687580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "621 LAKEVIEW RD",
"address_2": "SUITE B",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337563364",
"telephone_number": "727-461-9808",
"fax_number": "727-461-9809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 LAKEVIEW RD",
"address_2": "SUITE B",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337563364",
"telephone_number": "727-461-9808",
"fax_number": "727-461-9809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ERIC",
"middle_name": "EUGENE",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA13827",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clearwater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.