DR. WILLIAM CASSIDY WILSON IV (NPI# 1366861841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366861841 |
| Entity Type | Individual |
| Full Name | DR. WILLIAM CASSIDY WILSON IV |
| Credential | MD |
| Practice Address |
510 S Kingshighway Blvd Saint Louis MO 63110-1016 |
| Mailing Address |
660 S Euclid Ave Cb 8131 Saint Louis MO 63110-1010 |
| Practice Telephone | 3143627200 |
| Practice Fax Number | 3147474189 |
| Mailing Telephone | 3143627200 |
| Mailing Fax Number | 3147474189 |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2019-07-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
2019009534 | MO | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
2019009534 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 200067605 | 05 | |
| IL | ENROLLED | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518515444 | William Wilson | Physician Assistant | 1037 E Caldwell St, Louisville, KY 40204-1857 | 2019-09-04 |
| 1437563293 | William Scot Wilson | Pharmacist | 285 Dunlop Blvd Sw, Suite A, Huntsville, AL 35824-1119 | 2014-06-19 |
| 1003188517 | William Carrel Wilson | Veterinarian | 1599 Major Ave, Riverton, WY 82501-2326 | 2012-01-30 |
| 1477889632 | William Lee Wilson | Massage Therapist | 9900 Sw Wilshire St # 190g, Portland, OR 97225-5035 | 2009-10-22 |
| 1144469644 | William Jarrett Wilson | Registered Nurse | 1554 Ainsworth Ln, Lincoln, CA 95648-3233 | 2009-02-07 |
| 1750570925 | William H Wilson | Chiropractor | 3701 Division St, Suite 131, Metairie, LA 70002-4617 | 2007-10-23 |
| 1316156417 | William Thomas Wilson | Social Worker | 455 Bay St, Suite F, Petoskey, MI 49770-4401 | 2007-05-22 |
| 1114040367 | William F Wilson Jr. | Dentist | 850 Desoto Ave, Extended, Clarksdale, MS 38614 | 2007-04-10 |
| 1336269208 | William Wilson | Ophthalmology | 415 Lakewood Dr, Hamilton, GA 31811-3636 | 2007-04-02 |
| 1902939267 | William Allen Wilson | Internal Medicine | 9261 Old Keene Mill Rd, Burke, VA 22015 | 2007-03-14 |
| Street Address |
510 S KINGSHIGHWAY BLVD |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63110-1016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033107982 | Laurie L Fajardo | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2005-10-13 |
| 1902442650 | Amir Iravani Tabrizipour | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-11-18 |
| 1942850078 | Paul-robert Derenoncourt | Nuclear Medicine | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2019-09-20 |
| 1659861615 | Alexander Baireddy Reddy | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110 | 2018-05-15 |
| 1508356700 | Daniel Crawford | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-05-14 |
| 1154826675 | Eric Weiner | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-27 |
| 1447754767 | Allison L Schell | Physician Assistant | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2018-03-21 |
| 1407381262 | Philip Andrew Velez | Student in an Organized Health Care Education/Training Program | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2017-04-28 |
| 1154778959 | Jimmy Xu | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2016-05-21 |
| 1124402573 | Wei Wang | Radiology | 510 S Kingshighway Blvd, Dept Radiology, Saint Louis, MO 63110-1016 | 2015-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971992 | Carrie Ellen Smith | Nurse Practitioner | Mailstop 90-00-174, One Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-10-27 |
| 1881210466 | Michelle Amanda Freilich | Internal Medicine | Barnes-jewish Plaza, St. Louis, MO 63110 | 2020-06-19 |
| 1245856046 | Jeevin Shahi | Radiology | 3685 Vista Avenue, Center for Radiation Medicine, St. Louis, MO 63110 | 2020-06-18 |
| 1497371314 | Wilson Eduardo Rodriguez | Student in an Organized Health Care Education/Training Program | 1008 S. Spring, St Louis, MO 63110 | 2020-06-17 |
| 1578184065 | Kathryn Kay Lindsay | Registered Nurse | Saint Louis University Dept of Surgery, 3635 Vista Ave 3dt, St Louis, MO 63110 | 2020-05-06 |
| 1881232700 | Ashley Diane Pace | Nurse Practitioner | 1 Parkview Place, Shoenberg 6900, St. Louis, MO 63110 | 2019-12-11 |
| 1619520418 | Krithika Damodar Shenoy | Pathology | 660 Euclid Avenue, One Barnes Jewish Hospital Plaza, St. Louis, MO 63110 | 2019-07-20 |
| 1467912550 | Ian Ferguson | Dermatology | 660 S Euclid Ave., Cb 8123, St. Louis, MO 63110 | 2019-03-23 |
| 1760978688 | Ihab Hassanieh | Student in an Organized Health Care Education/Training Program | 33660 Vista Ave, St. Louis, MO 63110 | 2018-07-03 |
| 1336634500 | Martin K Mwangi | Pediatrics | 1 Childrens Place, 3s34, St. Louis, M, MO 63110 | 2018-06-28 |
| Find all providers in zip 63110 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003353152 | E-cloud Radiology LLC | Radiology | 7304 Stream Valley Ct, Saint Louis, MO 63129-5291 | 2017-01-27 |
| 1184828410 | John Gerard Ryan | Radiology | Mallinckrodt Institute of Radiology - Barnesjewish Hosp, 510 South Kingshighway Blvd., Saint Louis, MO 63110 | 2007-06-12 |
| 1174527584 | Edward O'brien | Radiology | 9930 Watson Rd, Saint Louis, MO 63126-1827 | 2005-06-13 |
| 1720427982 | Aaron Joseph Mintz | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1076 | 2013-06-21 |
| 1710242516 | Maria Zulfiqar | Radiology | 510 S Kingshighway Blvd, Saint Louis, MO 63110-1016 | 2012-07-08 |
| 1255457271 | Yihua Zhou | Radiology | 3635 Vista At Grand, Radiology Dept - Sluh, Saint Louis, MO 63110-0250 | 2007-03-21 |
| 1619081940 | Professional Imaging LLC | Radiology | 777 S New Ballas Rd, Suite 005, Saint Louis, MO 63141-8705 | 2006-08-17 |
| 1194735282 | Numan C Balci | Radiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2006-08-09 |
| 1972523322 | Michael K Wolverson | Radiology | 3635 Vista Ave, Saint Louis, MO 63110-2539 | 2006-07-20 |
| 1518932888 | Mary Catherine Lowdermilk | Radiology | 6420 Clayton Rd, Saint Louis, MO 63117-1811 | 2006-02-21 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63110 |
Please comment or provide details below to improve the information on DR. WILLIAM CASSIDY WILSON IV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.