Lawrence Woodrow Wilson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

99-332 Issued in NM

Practice address

5701 Balloon Fiesta Parkway
Care of Blue Cross Blue Shield of New Mexico
Albuquerque, NM 87113

Phone

(505) 816-2093

Fax

(505) 816-3608

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

Yes

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)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639229040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 BALLOON FIESTA PARKWAY",
            "address_2": "CARE OF BLUE CROSS BLUE SHIELD OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87113",
            "telephone_number": "505-816-2093",
            "fax_number": "505-816-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 BALLOON FIESTA PARKWAY",
            "address_2": "CARE OF BLUE CROSS BLUE SHIELD OF NEW MEXICO",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87113",
            "telephone_number": "505-816-2093",
            "fax_number": "505-816-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LAWRENCE",
        "middle_name": "WOODROW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NM",
            "license": "99-332",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "4269",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kacee Jo Wilson, CNP
• Karen P. Wilson
• Katelyn Jeanne Wilson, PMHNP
• Katharine Wilson, RN, MSN, WHNP-BC
• Kourtney Wilson, LMHC
• Lewis Era Earl Wilson, R.PH.
• Lisa Wilson, LMHC, PROVISIONAL
• Lori M Wilson
• Louis Wilson
• Lucia Wilson

• Family Medicine Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Family Medicine Physician in New Mexico

• 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.

Verify at the official NPI Registry.