Provider Demographics
NPI:1710926746
Name:WILSON, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8702
Mailing Address - Country:US
Mailing Address - Phone:970-495-8490
Mailing Address - Fax:970-495-8499
Practice Address - Street 1:2695 ROCKY MOUNTAIN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8702
Practice Address - Country:US
Practice Address - Phone:970-495-8490
Practice Address - Fax:970-495-8499
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO47301208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO30029244Medicaid
COCO303609Medicare PIN
F30186Medicare UPIN
COCOAAA0070Medicare PIN