Individual
DR. ADAM SPACH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1405 SE 164TH AVE STE 102, VANCOUVER, WA 98683-9644
(360) 256-4425
(360) 254-1844
Mailing address
1405 SE 164TH AVE STE 102, VANCOUVER, WA 98683-9644
(360) 256-4425
(360) 254-1844
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD00034230
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011826007
REGENCE BLUE CROSS OF OR
OR
01
—
0130871
WA DEPT OF LABOR & INDUST
WA
01
—
300151208
REGENCE HMOO
OR
05
—
8197287
—
WA
01
—
98683A007
TRIWEST
WA
Enumeration date
03/23/2006
Last updated
07/08/2007
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