JILL MALLORY FADAL WILSON M.D. NPI 1275928897

NPI Information

  • NPI: 1275928897
  • Provider Name: JILL MALLORY FADAL WILSON, M.D.
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1389 CENTER DR STE 200
    PARK CITY, UT
    ZIP 84098
  • Phone: (970) 484-4757

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NPI Details

Jill Mallory Fadal Wilson, M.D. is a diagnostic radiology radiology in Park City, UT with 10 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Jill Mallory Fadal Wilson, M.D. NPI is 1275928897. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Graduation Year:2015

The provider's business location address is:

1389 CENTER DR STE 200
PARK CITY, UT
ZIP 84098-660
Phone: (970) 484-4757
Fax: (970) 484-4759

The NPI 1275928897 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 3/31/2015 and was last updated on 3/4/2024.

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
12085R0202XRadiologyDiagnostic Radiology15751AWYOMINGNo
22085R0202XRadiologyDiagnostic RadiologyDR.0070579COLORADONo
32085R0202XRadiologyDiagnostic Radiology10964555-1205UTAHYes
42085R0202XRadiologyDiagnostic Radiology35561NEBRASKANo

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: 3/30/2025

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