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General NPI Number Information
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NPI Number | 1629189279
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Entity Type | Individual
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Provider Name | ROBERT ALLEN WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 120 SOUTHWOOD DR
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City | CLINTON
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State | NC
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Zip | 28328-5002
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Country | US
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Telephone | 910-592-7981
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Fax |
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Provider Business Mailing Address
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Address Line | 328 NE 48TH ST
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City | OAK ISLAND
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State | NC
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Zip | 28465-5305
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Country | US
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Telephone | 919-593-3402
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NC3312
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License Number State | NC
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