Provider Demographics
NPI:1083050850
Name:WILSON, JAMES R (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:4229 PEARL RD # N2.42
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4218
Mailing Address - Country:US
Mailing Address - Phone:216-778-4414
Mailing Address - Fax:216-957-2008
Practice Address - Street 1:4229 PEARL RD # N2.42
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4218
Practice Address - Country:US
Practice Address - Phone:216-778-4414
Practice Address - Fax:216-957-2008
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018136208100000X, 2081P0004X
OH34.0140512081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation