Healthcare Provider Details

I. General information

NPI: 1518913680
Provider Name (Legal Business Name): JAMES ALLAN WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 100TH ST SW SUITE 26
LAKEWOOD WA
98499-2751
US

IV. Provider business mailing address

5920 100TH ST SW SUITE 26
LAKEWOOD WA
98499-2751
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-0756
  • Fax: 253-581-3787
Mailing address:
  • Phone: 253-588-0756
  • Fax: 253-581-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00026594
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMD00026594
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: