Provider Demographics
NPI:1881951440
Name:WILSON, CALEB DESPAIN (MD)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:DESPAIN
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CALEB
Other - Middle Name:D
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2210 KING BLVD
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3165
Mailing Address - Country:US
Mailing Address - Phone:307-577-4240
Mailing Address - Fax:307-577-0012
Practice Address - Street 1:2210 KING BLVD
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3165
Practice Address - Country:US
Practice Address - Phone:307-577-4240
Practice Address - Fax:307-577-0012
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11045A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology