NPI 1003287079 · live from the CMS NPI Registry
Jeffrey P Wilson, MD
Internal Medicine, Interventional Cardiology in Fenton, MO. National Provider Identifier 1003287079, active.
NPI record
| NPI | 1003287079 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Interventional Cardiology 207RI0011X |
| Practice location | 1011 Bowles Ave Ste 300, Fenton, MO 63026 |
| Practice phone | 636-496-5065 |
| Mailing address | 345 W Steamboat Dr Ste 601, North Sioux City, SD 57049 |
| Enumerated | October 15, 2015 |
| Last updated | July 16, 2026 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Interventional Cardiology | 207RI0011X | 147427 (MT) |
| Internal Medicine, Cardiovascular Disease | 207RC0000X | 036165783 (IL) |
| Internal Medicine, Interventional Cardiology | 207RI0011X | 036165783 (IL) |
| Internal Medicine, Interventional Cardiology primary | 207RI0011X | 2025010674 (MO) |
| Internal Medicine | 207R00000X | 036165783 (IL) |
| Internal Medicine, Interventional Cardiology | 207RI0011X | 10415 (SD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.