| Doctor Name: | RICHARD ROBERT WILSON |
| NPI Number: | 1033358924 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 30699 |
| Business Practice Address: | 1276 Nursery Hill Ln Arden Hills, MN - 551125783 |
| Business Phone Number: | 6512608042 |
| Business Fax Number: | |
| Mailing Address: | 1276 Nursery Hill Ln, ARDEN HILLS |
| State: | MN |
| Postal Code: | 551125783 |
| Phone Number: | 6512608042 |
| Fax Number: | |
| NPI Enumeration Date: | 02/17/2009 |
| NPI Last Update Date: | 02/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 30699 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |