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NPI Code Detail

MEDICARE: ROGER WILSON MD

MEDICARE: ROGER 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
12085R0202XDiagnostic Radiology Physician3112NV

General Provider Information

NPI Number : 1528001062
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER WILSON MD
Provider Business Mailing Address
First Line : 2020 PALOMINO LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4812
Country : US
Telephone Number : 702-759-7793
Fax Number : 702-598-1025
Provider Business Practice Location Address
First Line : 2020 PALOMINO LN
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89106-4812
Country : US
Telephone Number : 702-384-5210
Fax Number : 702-598-1025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 07/08/2007

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Directions to “ ROGER WILSON MD” Practice Location

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