Cody R Wilson, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

8849510-1204 Issued in UT

Practice address

2380 N 400 E Ste C
North Logan, UT 84341-1756

Phone

(435) 753-7337

Fax

(435) 750-6779

NPI assigned

Oct 16, 2009

Last updated

Oct 2, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: primarycarepediatrics.codywilsondo@111210.advancedmd-direct.com

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

• Primary Care Pediatrics

  • Pediatrics Physician
  • North Logan, UT
  • NPI 1588969539
  NPD (past)
• Remack LLC

  • Primary Care Clinic/Center
  • Logan, UT
  • NPI 1477926806
  NPD (past)
• Sanford World Clinics - Klamath Falls

  dba Sanford Children's Clinic Klamath Falls

  • Pediatrics Physician
  • Klamath Falls, OR
  • NPI 1720337504
  NPD (past)
• University Professional Services

  dba OHSU Home Infusion Pharmacy

  • Pharmacy
  • Beaverton, OR
  • NPI 1073054714
  NPD (past)

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569974400000",
    "number": "1619202108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2380 N 400 E STE C",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411756",
            "telephone_number": "435-753-7337",
            "fax_number": "435-750-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 N 400 E STE C",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411756",
            "telephone_number": "435-753-7337",
            "fax_number": "435-750-6779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 Daggett Ave",
            "address_purpose": "LOCATION",
            "city": "Klamath Falls",
            "state": "OR",
            "postal_code": "976011114",
            "country_code": "US",
            "telephone_number": "541-851-4800",
            "fax_number": "541-851-4801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CODY",
        "middle_name": "R",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-16",
        "last_updated": "2019-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "8849510-1204",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "6025",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel White
• Dennis Wildman, CSW
• Aubree Williams, BSN
• Lee Martin Williams Sr., LCSW, SUDC
• Tiera Williams, PTA
• Jan Wimmer, L.C.S.W.
• Wood Wound Care, LLC
• Robert P Young, M.D.

• Pediatrics Physician in North Logan, UT
• Providers in North Logan, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; 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.