Provider Demographics
NPI:1265629661
Name:WILSON, DAVID NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W MEMORIAL RD STE 321
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8300
Mailing Address - Country:US
Mailing Address - Phone:405-748-4726
Mailing Address - Fax:
Practice Address - Street 1:OBSTETRICAL HOSPITALISTS & WOMEN'S SERVICES
Practice Address - Street 2:1923 S. UTICA AVE.
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:405-748-4726
Practice Address - Fax:405-607-8497
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6100207V00000X
OK32606207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200510550AMedicaid
TX192312101OtherFIRSTCARE
TX8DD068OtherBCBS TX