Provider Demographics
NPI:1780601252
Name:WILSON, BRETT II (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:WILSON
Suffix:II
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:PO BOX 10040
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0040
Mailing Address - Country:US
Mailing Address - Phone:562-809-3528
Mailing Address - Fax:
Practice Address - Street 1:300 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4311
Practice Address - Country:US
Practice Address - Phone:805-682-7111
Practice Address - Fax:805-569-8368
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.026108207P00000X
CAA97199207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A971990Medicaid
CAWA97199AMedicare PIN
CA00A971990Medicaid