Provider Demographics
NPI:1669654760
Name:BRETT WILSON II MD INC
Entity type:Organization
Organization Name:BRETT WILSON II MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-618-0335
Mailing Address - Street 1:1114 STATE ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2717
Mailing Address - Country:US
Mailing Address - Phone:805-964-3838
Mailing Address - Fax:805-964-6946
Practice Address - Street 1:351 S PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2403
Practice Address - Country:US
Practice Address - Phone:805-696-7920
Practice Address - Fax:805-696-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA971992083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty