Robert Harrison Wilson MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD00014627 Issued in WA

Legal business name

ROBERT HARRISON WILSON MD

Practice address

4401 Bridgeport Way W
University Place, WA 98466-4201

Phone

(253) 564-4157

Fax

(253) 564-4813

NPI assigned

Mar 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Jonathan Kaboos

Title

Office Manager

Phone

(253) 564-4157

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• robert h. wilson, md Other name

Locations

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

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1851561682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664201",
            "telephone_number": "253-564-4157",
            "fax_number": "253-564-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 BRIDGEPORT WAY W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664201",
            "telephone_number": "253-564-4157",
            "fax_number": "253-564-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT HARRISON WILSON MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "KABOOS",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-564-4157",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00014627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1214600",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "robert h. wilson, md",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• William Thomas Ritchie, M.D.
• Madison Ritsema, CCC-SLP
• Dennis Glen Rittenhouse, PHARMACY TECHNICIAN
• Barbara Rix, DNP
• Ann M Robbins
• Brittney Jean Roberto
• Catherine Robinson, RN
• Ivan T Robinson, LMT
• Candice Rodriguez, RN
• Tatiana Rodriguez

• Specialist in University Place, WA
• Providers in University Place, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.