Provider Demographics
NPI:1295797413
Name:WILSON, CHRISTOPHER ALLEN (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:WILSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-545-0176
Practice Address - Street 1:1600 N. GRAND AVE.
Practice Address - Street 2:STE 260
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2729
Practice Address - Country:US
Practice Address - Phone:719-562-2010
Practice Address - Fax:719-562-2097
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0031499207Q00000X, 207QH0002X
CO31499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01314996Medicaid
CO507546YK2DMedicare PIN
COE67895Medicare UPIN
CO01314996Medicaid