Basic Information
| Provider Information | |||||||||
| NPI: | 1255335527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 721678 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730708284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053607337 | ||||||||
| FaxNumber: | 8662590044 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WALL ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053607337 | ||||||||
| FaxNumber: | 8662590044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 17516 | OK | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.