Provider Demographics
NPI:1285655662
Name:WILSON, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 CLAYTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1354
Mailing Address - Country:US
Mailing Address - Phone:314-951-5368
Mailing Address - Fax:314-951-5238
Practice Address - Street 1:4116 VON TALGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1957
Practice Address - Country:US
Practice Address - Phone:314-815-3331
Practice Address - Fax:314-815-3703
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001015152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics