NPIMap

Organization Active NPI

P Nick Wilson MD Inc

  • Anesthesiology Physician
  • Murrieta, CA
National Provider Identifier
1639439805
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
615-07-2225 Issued in CA
Legal business name
P NICK WILSON MD INC
Practice address
25500 Medical Center Dr
Murrieta, CA 92562-5965
Phone
(951) 696-6000
Fax
(855) 898-4055
NPI assigned
May 22, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

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

Authorized official

Name
Mr. Paul Nicholas Wilson, M.D.
Title
Owner/ President
Phone
(310) 792-3914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 615-07-2225 CA Primary

Addresses

Primary practice location

25500 Medical Center Dr
Murrieta, CA 92562-5965

Mailing address

PO Box 3098
Torrance, CA 90510-3098
Phone (310) 792-3914

Other identifiers 1

IdentifierTypeStateIssuer
DR543ZOtherCAMEDICARE PTAN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1639439805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3098",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905103098",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25500 MEDICAL CENTER DR",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925625965",
            "telephone_number": "951-696-6000",
            "fax_number": "855-898-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P NICK WILSON MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-22",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "310-792-3914",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "615-07-2225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "DR543Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; 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.