Provider Demographics
NPI:1215307368
Name:WILSON, WESLEY GARTH (MD)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:GARTH
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 1:10540 E CORTEZ DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2939
Mailing Address - Country:US
Mailing Address - Phone:480-216-6887
Mailing Address - Fax:
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Practice Address - Street 2:SUITE120
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4134
Practice Address - Country:US
Practice Address - Phone:480-513-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21680208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery