| NPI Details | |
|---|---|
| NPI | 1073608659 |
| Gender | Male |
| Enumeration Date | 10/03/2006 |
| Last Updated | 10/15/2012 |
| Entity Type | Individual |
| Active | Over 11 years ago |
| Practice Location | |
|---|---|
| 1034 NORTH 500 WEST UTAH VALLEY REGIONAL MEDICAL CENTER PROVO UT, 84604, US |
|
| Phone | (801) 507-5248 |
| Fax | (801) 733-5618 |
| Business Location | |
|---|---|
| 3340 NORTH CENTER ST #800 LEHI UT, 84043-7406, US |
|
| Phone | (801) 990-1911 |
| Fax | (801) 990-1912 |
| Toxanomy | |
|---|---|
| Taxonomy Code | 207L00000X |
| License State | Utah |
| License Number | 88-179937-1205 |
| Remove 1073608659 NPI Number | |
According to our database, Carl Thayne Wilson MD NPI is 1073608659, taxonomy code is 207L00000X and license number is 88-179937-1205, license state is located at Utah. Carl Thayne Wilson MD physically located at 1034 North 500 West, Provo UT, 84604. NPI Number Carl Thayne Wilson MD has the Individual type.
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1073608659 NPI number is provided on an as is basis without warranty of any kind. 1073608659 is maintained by the National Plan & Provider Enumeration System. The contents of Carl Thayne Wilson MD are for informational purposes only.
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