Provider Demographics
NPI:1043287618
Name:WILSON, CHRISTOPHER JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JEROME
Last Name:WILSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 RIVER PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4605
Mailing Address - Country:US
Mailing Address - Phone:916-457-4263
Mailing Address - Fax:916-731-7809
Practice Address - Street 1:1515 RIVER PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4605
Practice Address - Country:US
Practice Address - Phone:916-457-4263
Practice Address - Fax:916-731-7809
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36565207XS0106X
CAA106196207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1047304594Medicare NSC