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Contact Information

SAMUEL M WILSON, DO
210 W 300 N
ROOSEVELT, UT84066-2336
 Phone: 435-722-4691
 Fax: 435-722-9291
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for SAMUEL M WILSON · (Male)

NPI # 1477865194
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 07/10/2010
Last updated 11/02/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • UT License # 5131797-1204
  • WA License # OP60440339
Hospital affiliation(s)
  • UINTAH BASIN MEDICAL CENTER - (Acute Care)
    250 WEST 300 NORTH (75-2)
    ROOSEVELT, UT 84066
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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