Doctor Name: | SAMUEL M. WILSON |
NPI Number: | 1477865194 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | |
Business Practice Address: | 2320 Freeway Drive Skagit Regional Clinics-riverbend Mount Vernon, WA - 98273 |
Business Phone Number: | 3608146800 |
Business Fax Number: | 3608146917 |
Mailing Address: | 1400 E Kincaid St, Attn: Credentialing MOUNT VERNON |
State: | WA |
Postal Code: | 982744127 |
Phone Number: | 3604282500 |
Fax Number: | 3604286485 |
NPI Enumeration Date: | 07/10/2010 |
NPI Last Update Date: | 05/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |