Active NPI
Robert Lyon Wilson, M.D.
- Gastroenterology Physician
- Oklahoma City, OK
National Provider Identifier
1306821780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 13185
- Practice address
- 4201 S Western Ave
Oklahoma City, OK 73109-3410 - Phone
- (405) 632-4000
- Fax
- (405) 632-4073
- NPI assigned
- Dec 8, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 13185 | OK | Primary |
Addresses
Primary practice location
4201 S Western Ave
Oklahoma City, OK 73109-3410
Mailing address
4201 S Western Ave
Oklahoma City, OK 73109-3410
Phone (405) 632-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100095080A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310342400000",
"number": "1306821780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4201 S WESTERN AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731093410",
"telephone_number": "405-632-4000",
"fax_number": "405-632-4073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 S WESTERN AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731093410",
"telephone_number": "405-632-4000",
"fax_number": "405-632-4073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ROBERT",
"middle_name": "LYON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-08",
"last_updated": "2011-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "OK",
"license": "13185",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100095080A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.