MEDICARE: DR. JAMES ALLAN WILSON MD

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
1	207Q00000X	Family Medicine Physician	MD00026594	WA
2	207VX0000X	Obstetrics Physician	MD00026594	WA

General Provider Information

NPI Number	:	1518913680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ALLAN WILSON MD

Provider Business Mailing Address
First Line	:	5920 100TH ST SW
Second Line	:	SUITE 26
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2751
Country	:	US
Telephone Number	:	253-588-0756
Fax Number	:	253-581-3787

Provider Business Practice Location Address
First Line	:	5920 100TH ST SW
Second Line	:	SUITE 26
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2751
Country	:	US
Telephone Number	:	253-588-0756
Fax Number	:	253-581-3787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/21/2007

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