Provider Demographics
NPI:1114085610
Name:WILSON, PATRICK T (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:T
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:303-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2581132080P0203X
CODR.00692042080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018882250001Medicaid
OH364140OtherWELLCARE
OH751030OtherBUCKEYE
OH000000221132OtherUNISON
OH7118897OtherAETNA
OH000000526171OtherANTHEM
OH2712603Medicaid
OH2712603Medicaid
OH000000526171OtherANTHEM
OHI64860Medicare UPIN