Individual
DR. CHARLES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
665 WINTER ST SE, SALEM, OR 97301-3919
(503) 561-5634
Mailing address
PO BOX 2505, SALEM, OR 97308-2505
(888) 828-3198
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD09689
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116012
MARION POLK CHP
—
05
—
116012
—
OR
05
—
8302143
—
WA
01
—
A020
CHAMPUS
—
01
—
A44718
PROVIDENCE
—
01
—
FM1W751
PACC
—
01
—
M400711
PACIFIC SOURCE
—
05
—
XPY049920
—
CA
Enumeration date
09/05/2006
Last updated
12/19/2007
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