Provider Demographics
NPI:1639277882
Name:WILSON, JOHN HANNAHS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HANNAHS
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 1:14502 W MEEKER BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5282
Mailing Address - Country:US
Mailing Address - Phone:623-524-8814
Mailing Address - Fax:
Practice Address - Street 1:2120 S HIGHLAND DR APT 339
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3197
Practice Address - Country:US
Practice Address - Phone:443-301-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044833207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD057621200Medicaid
MD270L31CCMedicare PIN