DR. THADDEUS DAVID WILSON M.D. NPI 1417190869

NPI Information

  • NPI: 1417190869
  • Provider Name: DR. THADDEUS DAVID WILSON, M.D.
  • Classification: Emergency Medicine - 207P00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4204 GARDENDALE ST
    SUITE 312
    SAN ANTONIO, TX
    ZIP 78229
  • Phone: (210) 293-6003

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NPI Details

DR. Thaddeus David Wilson, M.D. is an emergency medicine in San Antonio, TX. The provider is an emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. DR. Thaddeus David Wilson, M.D. NPI is 1417190869. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4204 GARDENDALE ST
SUITE 312
SAN ANTONIO, TX
ZIP 78229-132
Phone: (210) 293-6003

The NPI 1417190869 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/15/2009 and was last updated on 2/21/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207P00000XEmergency Medicine58235TENNESSEEYes
2207PP0204XEmergency MedicinePediatric Emergency MedicineQ4343TEXASNo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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