Active NPI
Elizabeth S Wilson, MD
- Pediatrics Physician
- Canon City, CO
National Provider Identifier
1679738132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 50901
- Practice address
- 614 Yale PL
Canon City, CO 81212-4611 - Phone
- (719) 285-2700
- Fax
- (719) 285-2975
- NPI assigned
- Jul 24, 2008
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 50901 | CO | Primary |
Addresses
Primary practice location
614 Yale PL
Canon City, CO 81212-4611
Mailing address
614 Yale PL
Canon City, CO 81212-4611
Phone (719) 285-2700
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50901 | CO | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402358400000",
"number": "1679738132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "614 YALE PL",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812124611",
"telephone_number": "719-285-2700",
"fax_number": "719-285-2975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "614 YALE PL",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812124611",
"telephone_number": "719-285-2700",
"fax_number": "719-285-2975"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ELIZABETH",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-24",
"last_updated": "2014-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CO",
"license": "50901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.