Healthcare Provider Details

I. General information

NPI: 1962473496
Provider Name (Legal Business Name): ROBERT BRUCE WILSON II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 JAKE ALEXANDER BLVD W
SALISBURY NC
28147-1442
US

IV. Provider business mailing address

320 JAKE ALEXANDER BLVD W SUITE 103
SALISBURY NC
28147-1442
US

V. Phone/Fax

Practice location:
  • Phone: 704-797-0065
  • Fax: 704-797-0067
Mailing address:
  • Phone: 704-797-0065
  • Fax: 704-797-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9601527
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number9601527
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: