Provider Demographics
NPI:1477633121
Name:VICTOR T. WILSON MD PC
Entity Type:Organization
Organization Name:VICTOR T. WILSON MD PC
Other - Org Name:CARING PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-360-7337
Mailing Address - Street 1:PO BOX 721678
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8284
Mailing Address - Country:US
Mailing Address - Phone:405-360-7337
Mailing Address - Fax:866-259-0044
Practice Address - Street 1:700 WALL ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6360
Practice Address - Country:US
Practice Address - Phone:405-360-7337
Practice Address - Fax:866-259-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100189500DMedicaid
OK100189500DMedicaid
OK200522090Medicare ID - Type Unspecified