Active NPI
Gayle Ray Wilson, MD
- Family Medicine Physician
- Dallas, OR
National Provider Identifier
1437215340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD09317
- Practice address
- 289 E Ellendale
Suite 503
Dallas, OR 97338 - Phone
- (503) 623-8826
- Fax
- (503) 623-8739
- NPI assigned
- Dec 28, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD09317 | OR | Primary |
Addresses
Primary practice location
289 E Ellendale
Suite 503
Dallas, OR 97338
Mailing address
PO Box 26
Dallas, OR 97338
Phone (503) 623-8826
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004460 | Medicaid | OR |
Other names 1
- G R Wilson
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": "1167264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437215340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26",
"city": "DALLAS",
"state": "OR",
"postal_code": "97338",
"telephone_number": "503-623-8826",
"fax_number": "503-623-8739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "289 E ELLENDALE",
"address_2": "SUITE 503",
"city": "DALLAS",
"state": "OR",
"postal_code": "97338",
"telephone_number": "503-623-8826",
"fax_number": "503-623-8739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "GAYLE",
"middle_name": "RAY",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD09317",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004460",
"state": "OR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "G",
"last_name": "WILSON",
"middle_name": "R",
"credential": "MD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Dallas, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.