Individual
DR. RICHARD SCOTT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4620 VILLAGE SQUARE DRIVE, PADUCAH, KY 42001-7501
(270) 442-8575
(270) 442-8783
Mailing address
P O BOX 9100, PADUCAH, KY 42002-9100
(270) 442-8575
(270) 442-8783
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
41142
KY
207R00000X
Internal Medicine Physician
Primary
41142
KY
207R00000X
Internal Medicine Physician
654-L
MS
208M00000X
Hospitalist Physician
41142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100050700
—
KY
01
—
CB8326
RAILROAD MEDICARE GROUP
—
01
—
P00612564
RAILROAD MEDICARE INDIVIDUAL
—
Enumeration date
06/27/2007
Last updated
10/07/2019
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