Healthcare Provider Details

I. General information

NPI: 1841415932
Provider Name (Legal Business Name): ROBERT W. WILSON, D.O., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
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:
Mailing address:
  • Phone: 239-598-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number0S0006131
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT WILCOX WILSON
Title or Position: OWNER
Credential: D.O.,P.A.
Phone: 239-598-5750