Individual
MR. ANTHONY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
155 S EMPIRE BLVD, COOS BAY, OR 97420-3374
(541) 256-4686
Mailing address
1942 SHERIDAN AVE, NORTH BEND, OR 97459-3416
(541) 256-4686
(541) 756-2111
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
19-CRM-044
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19-CRM-044
MHACBO
OR
Enumeration date
02/15/2019
Last updated
01/31/2020
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