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General NPI Number Information
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NPI Number | 1790745933
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Entity Type | Individual
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Provider Name | ADAM SPACH WILSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1405 SE 164TH AVE STE 102
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-256-4425
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Fax | 360-254-1844
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Provider Business Mailing Address
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Address Line | 1405 SE 164TH AVE STE 102
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City | VANCOUVER
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State | WA
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Zip | 98683-9644
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Country | US
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Telephone | 360-256-4425
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Fax | 360-254-1844
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD00034230
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License Number State | WA
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