Active NPI
Deidre A Wilson, D.O.
- General Practice Physician
- Phoenix, AZ
National Provider Identifier
1760634471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4042
- Practice address
- 8326 N 7TH St
Phoenix, AZ 85020-3441 - Phone
- (602) 305-5100
- NPI assigned
- Oct 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4042 | AZ | Primary |
Addresses
Primary practice location
8326 N 7TH St
Phoenix, AZ 85020-3441
Mailing address
1180 Newfield Ave
Stamford, CT 06905-1409
Phone (314) 888-5233
Other practice location 1
103 E Indiana Ave # B
Spokane, WA 99207-2317
Phone (509) 444-9035
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 Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4042 | AZ | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1760634471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1180 NEWFIELD AVE",
"city": "STAMFORD",
"state": "CT",
"postal_code": "069051409",
"telephone_number": "314-888-5233"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8326 N 7TH ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850203441",
"telephone_number": "602-305-5100"
}
],
"practiceLocations": [
{
"address_1": "103 E Indiana Ave # B",
"address_purpose": "LOCATION",
"city": "Spokane",
"state": "WA",
"postal_code": "992072317",
"country_code": "US",
"telephone_number": "509-444-9035",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WILSON",
"first_name": "DEIDRE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-14",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "AZ",
"license": "4042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 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.