Provider Demographics
NPI:1932190782
Name:WILSON, ROY M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:M
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 1:13611 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-5701
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:UNIVERSITY OF COLORADO HOSPITAL
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7109
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45762207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74528319Medicaid
TX8G7983OtherBC/BS
TX87458ZOtherHMO BLUE
NMD005OtherTRIWEST
NM82915Medicaid
NM82915OtherPRESBYTERIAN COMMERCIAL
TXBW0578368OtherDEA
TXBW0578368OtherDEA
NM82915Medicaid