Individual
DR. ROBERT WAYNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 SE 3RD AVE, FORT LAUDERDALE, FL 33316-1139
(954) 522-3132
Mailing address
147 OLDE POINT ROAD, HMPSTEAD, NC 28443
(910) 512-4434
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
31696
NC
2084P0800X
Psychiatry Physician
Primary
ME113477
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006432000
—
FL
01
—
88423
BCBS
NC
05
—
8988423
—
NC
Enumeration date
11/20/2006
Last updated
05/25/2017
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