Provider Demographics
NPI:1508040072
Name:WILSON, REBECCA J (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12709 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1140
Mailing Address - Country:US
Mailing Address - Phone:816-941-0528
Mailing Address - Fax:
Practice Address - Street 1:2411 HOLMES ST
Practice Address - Street 2:M1-210
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2741
Practice Address - Country:US
Practice Address - Phone:816-235-6626
Practice Address - Fax:816-235-6629
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011010014207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine