Individual
DR. SHAWN H WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
110 S 9TH AVE, YAKIMA, WA 98902-3315
(509) 575-5061
Mailing address
3916 STATE ST, #300, SANTA BARBARA, CA 93105-5602
(800) 230-5160
(805) 564-5087
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OP00002116
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212148
LABOR & INDUSTRIES - YAKIMA LOCATION
WA
01
—
4141WI
BLUESHIELD - YAKIMA LOCATION
WA
05
—
8461048
—
WA
01
—
P00339532
RAILROAD MEDICARE
WA
Enumeration date
08/05/2006
Last updated
06/30/2010
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