Basic Information
| Provider Information | |||||||||
| NPI: | 1093918088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | TRENTON | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 NORTH 20TH ST. #18 | ||||||||
| Address2: | THE ORTHOPAEDIC CLINIC P.C. | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Practice Location | |||||||||
| Address1: | 121 NORTH 20TH ST #18 | ||||||||
| Address2: | THE ORTHOPAEDIC CLINIC P.C. | ||||||||
| City: | OPELIKA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 368015457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347498303 | ||||||||
| FaxNumber: | 3347455243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 29329 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.