| Organization Name: | RICHARD R. WILSON, D.O. |
| NPI Number: | 1497938963 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD R WILSON (DOCTOR/OWNER) |
| Mailing Address: | 10201 Arcos Ave Suite 202 Estero |
| State: | FL US |
| Postal Code: | 33928 |
| Phone Number: | 2399491212 |
| Fax Number: | 2399490587 |
| NPI Enumeration Date: | 12/07/2007 |
| NPI Last Update Date: | 11/20/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS9100 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |