Provider Demographics
NPI:1225004898
Name:WILSON, DEBORAH LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 N 92ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4511
Mailing Address - Country:US
Mailing Address - Phone:480-661-2662
Mailing Address - Fax:480-661-9716
Practice Address - Street 1:10301 N 92ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4511
Practice Address - Country:US
Practice Address - Phone:480-661-2662
Practice Address - Fax:480-661-9716
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ46782001Medicaid
AZH11936Medicare UPIN
AZ34WCHYS06Medicare ID - Type UnspecifiedMEDICARE