Healthcare Provider Details

I. General information

NPI: 1619971090
Provider Name (Legal Business Name): REX DUANE WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2175 ROSALINE AVE
REDDING CA
96001-2509
US

IV. Provider business mailing address

2175 ROSALINE AVE
REDDING CA
96001-2549
US

V. Phone/Fax

Practice location:
  • Phone: 530-242-5745
  • Fax:
Mailing address:
  • Phone: 530-225-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG86692
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG86692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: