Organization
ROBERT W. WILSON, D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT WILCOX WILSON D.O.,P.A. (OWNER)
(239) 598-5750
Entity
Organization
Contact information
Practice address
2940 IMMOKALEE RD, SUITE #2, NAPLES, FL 34110-1409
(239) 598-5750
Mailing address
2940 IMMOKALEE RD, SUITE #2, NAPLES, FL 34110-1409
(239) 598-5750
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0S0006131
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202096
FL HEALTHY KIDS
FL
01
—
435695
GREAT WEST
—
01
—
80906
BLUE CROSS BLUE SHIELD
—
Enumeration date
04/16/2007
Last updated
08/22/2020
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