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Provider Information for 1811159452

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

JASON WILSON MD

Gender: MALE

Individual NPI: 1811159452

Calendar   Last Updated:  2022-04-25
  Certification Date:  2022-04-25

Details

Name Value
NPI 1811159452
Enumeration Date 2008-06-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2540 W MARYLAND AVE
TAMPA, FL 33629-6233
United States

Phone: 813-843-2110 | Fax:
View Map External Link
Primary Practice Address 1 DAVIS BLVD
TAMPA, FL 33606-3463
United States

Phone: 813-843-2110 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Direct Messaging Address jwilson18281@direct.tgh.org 1 DAVIS BLVD
TAMPA, FL 33606-3463
United States
Other Identifiers
Issuer State Number
Other BSFL FL 14E16
MEDICAID FL 003616000
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207P00000X - Emergency Medicine FL ME105890