Provider Demographics
NPI:1811266331
Name:DEBORAH D WILSON M D P C
Entity type:Organization
Organization Name:DEBORAH D WILSON M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-860-4791
Mailing Address - Street 1:10250 N 92ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4517
Mailing Address - Country:US
Mailing Address - Phone:480-860-4791
Mailing Address - Fax:480-860-6314
Practice Address - Street 1:10250 N 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4517
Practice Address - Country:US
Practice Address - Phone:480-860-4791
Practice Address - Fax:480-860-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD26168207V00000X, 207V00000X, 207V00000X
AZAP0886363L00000X
AZAP2435363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266701001Medicaid
Z155360191Medicare PIN
AZ266701001Medicaid