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NPI Code Detail

MEDICARE: DAVID JEAN WILSON MD

MEDICARE: DAVID JEAN 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
1207W00000XOphthalmology PhysicianMD13338OR
2207WX0107XRetina Specialist (Ophthalmology) PhysicianMD13338OR

General Provider Information

NPI Number : 1316999642
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID JEAN WILSON MD
Provider Business Mailing Address
First Line : PO BOX 4183
Second Line :
City : PORTLAND
State : OR
Zip : 97208
Country : US
Telephone Number : 503-494-6107
Fax Number : 503-494-0470
Provider Business Practice Location Address
First Line : 3375 SW TERWILLIGER BLVD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-4146
Country : US
Telephone Number : 503-494-3000
Fax Number : 503-494-4286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 10/23/2017

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Directions to “ DAVID JEAN WILSON MD” Practice Location

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