Basic Information
| Provider Information | |||||||||
| NPI: | 1467695072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 GUSDORF RD STE A | ||||||||
| Address2: | |||||||||
| City: | TAOS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875716499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757580009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 940 CENTRAL PARK DR STE 280 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804878853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708796663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD2016-0171 | NM | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.