Provider Demographics
NPI:1851316517
Name:WILSON, LLOYD PAUL (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:PAUL
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440
Mailing Address - Country:US
Mailing Address - Phone:541-687-7134
Mailing Address - Fax:541-687-7135
Practice Address - Street 1:1200 HILYARD ST STE 410
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8158
Practice Address - Country:US
Practice Address - Phone:541-681-8586
Practice Address - Fax:541-681-8587
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD117152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR8004138-01OtherBCBS
WA8296717Medicaid
AKMD5436RMedicaid
OR260828Medicaid
OR8005089-09OtherBCBS
AKMD5435RMedicaid
ORP00384405Medicare PIN
ORR135803Medicare PIN
ORR00WCPGHIMedicare PIN
OR260828Medicaid
OR8004138-01OtherBCBS
AKMD5436RMedicaid
ORR300032396Medicare PIN