Provider Demographics
NPI:1275554446
Name:WILSON, JOEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:MS 315010
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3947
Mailing Address - Country:US
Mailing Address - Phone:425-454-2656
Mailing Address - Fax:425-455-2620
Practice Address - Street 1:1135-116TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-2656
Practice Address - Fax:425-455-2620
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0070298207RC0000X
CAA122356207RC0000X
WAMD00046763207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8457921Medicaid
WA8457921Medicaid
WA8457921Medicaid