Provider Demographics
NPI:1992736367
Name:WILSON, BYRON ERIC (MD)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:ERIC
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5725 W LAS POSITAS BLVD
Mailing Address - Street 2:#100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4054
Mailing Address - Country:US
Mailing Address - Phone:925-734-8130
Mailing Address - Fax:925-225-0121
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:#130
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-888-0657
Practice Address - Fax:510-886-4532
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72444207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
900002477OtherRAILROAD MEDICARE
CA00G724440Medicaid
CA00G724440Medicaid
900002477OtherRAILROAD MEDICARE
F52843Medicare UPIN