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General NPI Number Information
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NPI Number | 1164456471
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Entity Type | Individual
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Provider Name | FREDERIC BARLOW WILSON I MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 80 N MAIN ST
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City | COUPEVILLE
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State | WA
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Zip | 98239-9500
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Country | US
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Telephone | 360-678-4424
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Fax | 360-678-5161
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Provider Business Mailing Address
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Address Line | 80 N MAIN ST
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City | COUPEVILLE
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State | WA
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Zip | 98239-9500
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Country | US
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Telephone | 360-678-4424
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Fax | 360-678-5161
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD00030372
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | MD00030372
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | MD00030372
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License Number State | WA
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