Basic Information
| Provider Information | |||||||||
| NPI: | 1669654760 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRETT WILSON II MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1114 STATE ST | ||||||||
| Address2: | SUITE 222 | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931012717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059643838 | ||||||||
| FaxNumber: | 8059646946 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 S PATTERSON AVE | ||||||||
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| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056967920 | ||||||||
| FaxNumber: | 8056967921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2007 | ||||||||
| LastUpdateDate: | 11/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8056180335 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083P0011X | A97199 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
No ID Information.