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General NPI Number Information
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NPI Number | 1609489921
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Entity Type | Organization
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Legal Business Name | ROBERT A WILSON MD
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 717 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-3459
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Country | US
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Telephone | 336-317-4591
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Fax |
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Provider Business Mailing Address
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Address Line | 717 N HOWE ST
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City | SOUTHPORT
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State | NC
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Zip | 28461-3459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | BRETT WELCH
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Credential | MBA, MHA
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Telephone | 336-317-4591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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