Basic Information
| Provider Information | |||||||||
| NPI: | 1861848939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 STANTON L YOUNG BLVD | ||||||||
| Address2: | WP-1380 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052715964 | ||||||||
| FaxNumber: | 4052714719 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 STANTON L YOUNG BLVD | ||||||||
| Address2: | PPB-111 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731045023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052714906 | ||||||||
| FaxNumber: | 4052714910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 32312 | OK | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.