Provider Demographics
NPI:1104812882
Name:WILSON, DELANO DONALD (MD)
Entity type:Individual
Prefix:
First Name:DELANO
Middle Name:DONALD
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEL
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17405 POND VIEW PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5303
Mailing Address - Country:US
Mailing Address - Phone:937-416-9120
Mailing Address - Fax:
Practice Address - Street 1:10TH MDG
Practice Address - Street 2:4102 PINION DR.
Practice Address - City:UAAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-8084
Practice Address - Country:US
Practice Address - Phone:719-333-5439
Practice Address - Fax:719-333-0507
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00433462085R0202X
OH350563482085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology