MEDICARE: DR. ROBERT G WILSON D.O.

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	174400000X	Specialist	OS8326	FL

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	:	1912996489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT G WILSON D.O.

Provider Business Mailing Address
First Line	:	2919 W SWANN AVE
Second Line	:	SUITE 401
City	:	TAMPA
State	:	FL
Zip	:	33609-4038
Country	:	US
Telephone Number	:	813-872-1548
Fax Number	:	813-872-7509

Provider Business Practice Location Address
First Line	:	2919 W SWANN AVE
Second Line	:	SUITE 401
City	:	TAMPA
State	:	FL
Zip	:	33609-4038
Country	:	US
Telephone Number	:	813-872-1548
Fax Number	:	813-872-7509

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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