Individual
DR. REGINALD WENDELL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19505 52ND AVE W, SUITE A, LYNNWOOD, WA 98036-5409
(206) 623-3814
(206) 623-4327
Mailing address
19505 52ND AVE W, SUITE A, LYNNWOOD, WA 98036-5409
(206) 623-3814
(206) 623-4327
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
030927
GA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD 60318390
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000787652A
—
GA
01
—
10049819
AMERIGROUP
GA
01
—
118365
PEACH STATE HLT PLANS
GA
01
—
297058
WELLCARE
GA
01
—
727301
BCBSGA PROVIDER #
GA
01
—
P00256641
RAILROAD MEDICARE
GA
Enumeration date
04/14/2006
Last updated
05/11/2017
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