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General NPI Number Information
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NPI Number | 1083050850
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Entity Type | Individual
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Provider Name | JAMES R WILSON DO
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Gender | Male
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 4229 PEARL RD # N2.42
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City | CLEVELAND
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State | OH
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Zip | 44109-4218
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Country | US
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Telephone | 216-778-4414
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Fax | 216-957-2008
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Provider Business Mailing Address
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Address Line | 4229 PEARL RD # N2.42
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City | CLEVELAND
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State | OH
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Zip | 44109-4218
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Country | US
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Telephone | 216-778-4414
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Fax | 216-957-2008
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OS018136
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | OS018136
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number | 34.014051
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License Number State | OH
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