NPI 1619202108

Cody R Wilson, DO

Practitioner Pediatrics Physician North Logan, UT

Practice location

Address: 2380 N 400 E STE C, North Logan, UT 84341-1756
Phone: (435) 753-7337
Fax: (435) 750-6779

Registered specialties (2)

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 8849510-1204 (UT)

Other Pediatrics providers in Utah →

Pediatrics Physician

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 6025 (NE)

Registry record

NPI: 1619202108
Entity type: Individual
Sex (as registered): Male
NPI issued: 16 Oct 2009
Record last updated: 2 Oct 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.