Provider Demographics
NPI:1316384472
Name:WILSON, DESMOND (MD)
Entity Type:Individual
Prefix:
First Name:DESMOND
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 1:1 DANIEL BURNHAM CT STE 370C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-0470
Mailing Address - Country:US
Mailing Address - Phone:415-732-7029
Mailing Address - Fax:415-732-7030
Practice Address - Street 1:166 GEARY STREET, STE 1500
Practice Address - Street 2:#1621
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-212-8356
Practice Address - Fax:866-872-8589
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty