Provider Demographics
NPI:1851367163
Name:WILSON, ROBIN T (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:T
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11784
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37939-1784
Mailing Address - Country:US
Mailing Address - Phone:865-588-2928
Mailing Address - Fax:865-450-9374
Practice Address - Street 1:137 BLOUNT AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:SD
Practice Address - Zip Code:37871
Practice Address - Country:US
Practice Address - Phone:865-632-5992
Practice Address - Fax:865-632-5316
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15034207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1740454OtherUHC
TN4011753OtherBCBS OF TN
TN3041941Medicaid
KY64913189Medicaid
TNB00326Medicare UPIN