Basic Information
| Provider Information | |||||||||
| NPI: | 1841325503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | SUE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9895 W. REMINGTON PLACE | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801286734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039482676 | ||||||||
| FaxNumber: | 3039049151 | ||||||||
| Practice Location | |||||||||
| Address1: | 9895 W. REMINGTON PLACE | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801286734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039482676 | ||||||||
| FaxNumber: | 3039049151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2007 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31699 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.