Healthcare Provider Details

I. General information

NPI: 1427018134
Provider Name (Legal Business Name): ROBERT WILCOX WILSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 IMMOKALEE RD SUITE 2
NAPLES FL
34110-1409
US

IV. Provider business mailing address

2940 IMMOKALEE RD SUITE 2
NAPLES FL
34110-1409
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-5750
  • Fax: 239-593-1989
Mailing address:
  • Phone: 239-598-5750
  • Fax: 239-593-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0019196
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: