Provider Demographics
NPI:1447373832
Name:WILSON, JOSHUA BRYCE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:BRYCE
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 1:12402 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8138
Mailing Address - Country:US
Mailing Address - Phone:515-360-0062
Mailing Address - Fax:
Practice Address - Street 1:6000 UNIVERSITY AVE STE 450
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8229
Practice Address - Country:US
Practice Address - Phone:515-241-2000
Practice Address - Fax:515-241-2005
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37211207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1447373832OtherBLUE CROSS BLUE SHIELD
IA1447373832OtherBLUE CROSS BLUE SHIELD