MEDICARE: DR. JOEL R WILSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	D0070298	MD
2	207RC0000X	Cardiovascular Disease Physician	A122356	CA
3	207RC0000X	Cardiovascular Disease Physician	MD00046763	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275554446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL R WILSON MD

Provider Business Mailing Address
First Line	:	PO BOX 3047
Second Line	:	MS 315010
City	:	SEATTLE
State	:	WA
Zip	:	98124-3947
Country	:	US
Telephone Number	:	425-454-2656
Fax Number	:	425-455-2620

Provider Business Practice Location Address
First Line	:	1135-116TH AVENUE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004
Country	:	US
Telephone Number	:	425-454-2656
Fax Number	:	425-455-2620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	03/21/2017

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