Individual
ROBERT MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
101 KNOTBREAK RD, SALEM, VA 24153-5404
(540) 444-4020
(540) 444-4021
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001209
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008953732
—
VA
Enumeration date
06/03/2006
Last updated
01/26/2022
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