Stewart M Wilson Jr., MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD08850 Issued in OR

Practice address

341 Medical Loop
Ste 120
Roseburg, OR 97471-5546

Phone

(541) 672-8288

Fax

(541) 672-0665

NPI assigned

Nov 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Centennial Medical Group Inc.

  • Surgery Physician
  • Roseburg, OR
  • NPI 1518103274
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451606400000",
    "number": "1467434969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "341 MEDICAL LOOP, SUITE 120",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974715575",
            "telephone_number": "541-672-8288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 MEDICAL LOOP",
            "address_2": "STE 120",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974715546",
            "telephone_number": "541-672-8288",
            "fax_number": "541-672-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "STEWART",
        "middle_name": "M",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-18",
        "last_updated": "2016-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OR",
            "license": "MD08850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213629",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colleen Elizabeth Wilson, CTRS
• Daniel Stuart Wilson
• Jennifer Ann Brough Wilson, PA
• Joshua Wilson
• Leonard Wilson, D.M.D.
• Wilt'S Emergency Service and Transport, Inc.
• Janice I Winstead, CADCII
• Stephanie Wirth
• Derek Wiseman, MD
• Michelle Wissel, CADC

• Ophthalmology Physician in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Ophthalmology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.