Individual
DR. ROBERT D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10379 SE CRESCENT RIDGE DR, PORTLAND, OR 97086-9100
(503) 777-6306
Mailing address
10379 SE CRESCENT RIDGE DR, PORTLAND, OR 97086-9100
(503) 777-6306
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD10867
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050036209
RR MEDICARE
OR
05
—
1374701
—
WA
Enumeration date
08/05/2006
Last updated
08/29/2012
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