Healthcare Provider Details

I. General information

NPI: 1124038104
Provider Name (Legal Business Name): ROBERT WILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

IV. Provider business mailing address

1850 HICKORY ST SUITE #102
ABILENE TX
79601-2334
US

V. Phone/Fax

Practice location:
  • Phone: 325-677-2801
  • Fax: 325-677-9110
Mailing address:
  • Phone: 325-677-2801
  • Fax: 325-677-9110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: