Individual
DR. RICHARD ALAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
885 MISSION STREET SE, SALEM, OR 97302
(503) 585-5585
(503) 587-7823
Mailing address
885 MISSION STREET SE, SALEM, OR 97302
(503) 585-5585
(503) 587-7823
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD13790
OR
207UN0901X
Nuclear Cardiology Physician
MD13790
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060046918
RAILROAD MEDICARE
OR
05
—
286138
—
OR
Enumeration date
08/03/2005
Last updated
11/10/2010
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