Provider Demographics
NPI:1891772117
Name:WILSON, MORGAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:SCOTT
Last Name:WILSON
Suffix:
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 1:322 VIA LAGUNA VIS
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-4763
Mailing Address - Country:US
Mailing Address - Phone:805-503-9493
Mailing Address - Fax:805-439-2186
Practice Address - Street 1:322 VIA LAGUNA VIS
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-4763
Practice Address - Country:US
Practice Address - Phone:805-503-9493
Practice Address - Fax:805-439-2186
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6625207ZP0102X
CAC41439207ZP0102X
LAMD015339207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID487374Medicaid
E48097Medicare UPIN