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General NPI Number Information
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NPI Number | 1457661480
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Entity Type | Organization
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Legal Business Name | ROBERT M. WILSON, M.D. INC.
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Dates
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Enumeration Date | 10/08/2010
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Last Update Date | 10/08/2010
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Provider Practice Location Address
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Address Line | 8631 W. 3RD STREET SUITE 1115E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5923
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Country | US
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Telephone | 310-289-0249
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Fax | 310-289-8179
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Provider Business Mailing Address
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Address Line | 8631 W. 3RD STREET SUITE 1115E
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City | LOS ANGELES
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State | CA
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Zip | 90048-5923
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Country | US
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Telephone | 310-289-0249
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Fax | 310-289-8179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT M WILSON
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Credential | M.D.
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Telephone | 310-289-0249
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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 | G51926
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License Number State | CA
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