MEDICARE: DR. ROBERT WAYNE 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	2084P0800X	Psychiatry Physician	31696	NC
2	2084P0800X	Psychiatry Physician	ME113477	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88423	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780758094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WAYNE WILSON MD

Provider Business Mailing Address
First Line	:	147 OLDE POINT ROAD
Second Line	:
City	:	HMPSTEAD
State	:	NC
Zip	:	28443
Country	:	US
Telephone Number	:	910-512-4434
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SE 3RD AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1139
Country	:	US
Telephone Number	:	954-522-3132
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	05/25/2017

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