Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 31499 | CO |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | DR.0031499 | CO |
NPI | 1295797413 |
---|---|
Provider Name | Dr. Christopher Allen Wilson |
First Address | Denver, CO 80256-0825 |
Second Address | Pueblo, CO 81003-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 31/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01314996 | (05) | CO |
E67895 | (02) | CO |