Provider Demographics
NPI:1225018096
Name:WILSON, MATTHEW P (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6567 E CARONDELET DR STE 305
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2156
Mailing Address - Country:US
Mailing Address - Phone:520-881-8400
Mailing Address - Fax:520-881-6563
Practice Address - Street 1:6567 E CARONDELET DR STE 305
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2156
Practice Address - Country:US
Practice Address - Phone:520-881-8400
Practice Address - Fax:520-881-6563
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ33588207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ951097Medicaid
AZ105305Medicare ID - Type Unspecified
AZ951097Medicaid