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NPI Code Detail

MEDICARE: ROBERT L WILSON M D INC

MEDICARE: ROBERT L WILSON M D INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianA23286CA

General Provider Information

NPI Number : 1346474889
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT L WILSON M D INC
Provider Business Mailing Address
First Line : 2815 W SUNSET BLVD
Second Line : 205
City : LOS ANGELES
State : CA
Zip : 90026-2167
Country : US
Telephone Number : 213-484-1271
Fax Number : 213-484-1217
Provider Business Practice Location Address
First Line : 2815 W SUNSET BLVD
Second Line : 205
City : LOS ANGELES
State : CA
Zip : 90026-2167
Country : US
Telephone Number : 213-484-1271
Fax Number : 213-484-1217
Authorized Official
Title or Position : CEO/ PRESIDENT
Name : DR. ROBERT L WILSON
Credential : M.D.
Telephone Number : 213-484-1271
Provider Enumeration Date : 05/12/2009
Last Update Date : 05/12/2009

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Directions to “ROBERT L WILSON M D INC ” Practice Location

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