Thomas J Wilson, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

5596A Issued in WY

Practice address

625 East Broadway
St Johns Medical Center Dept of Radiology
Jackson, WY 83001

Phone

(800) 633-1905

Fax

(913) 491-0411

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1689788655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9230",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830029230",
            "telephone_number": "800-633-1905",
            "fax_number": "913-491-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 EAST BROADWAY",
            "address_2": "ST JOHNS MEDICAL CENTER DEPT OF RADIOLOGY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "800-633-1905",
            "fax_number": "913-491-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "THOMAS",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WY",
            "license": "5596A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "5596A",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WYOMING BLUE",
            "identifier": "313044",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Larry Adam Williamson, LCPC
• Victoria Paige Willis
• Elizabeth Wilson, RBT
• Holland Wilson, LMFT
• Matia Wilson, LCSW
• Michael J Wine, DDS
• Womens Health & Family Care, LLC
• Womens Health Center
• Blane A Woodfin, MD
• Piper Worthington, LCSW

• Diagnostic Radiology Physician in Jackson, WY
• Providers in Jackson, WY by specialty
• Diagnostic Radiology Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.