Individual
DR. DOUGLAS A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
930 SW ABBEY ST STE B, NEWPORT, OR 97365-4820
(541) 574-7235
Mailing address
PO BOX 2847, CORVALLIS, OR 97339-2847
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301056816
MI
208600000X
Surgery Physician
M10679
ID
208600000X
Surgery Physician
Primary
MD157658
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010173389
REGENCE BLUE SHIELD
ID
01
—
0201174022
BLUE CROSS
MI
01
—
0249855
WASHINGTON LABOR & INDUSTRIES
WA
05
—
1679502918
—
MT
05
—
1679502918
—
WA
01
—
20039075
RAILROAD MEDICARE
MI
01
—
77943
BLUE CROSS
ID
05
—
808373700
—
ID
Enumeration date
06/30/2006
Last updated
03/07/2023
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