Provider Demographics
NPI:1902035678
Name:WILSON, ROBERT J (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:107 E REPARO CIR
Mailing Address - Street 2:
Mailing Address - City:BAYVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4755
Mailing Address - Country:US
Mailing Address - Phone:956-434-6398
Mailing Address - Fax:
Practice Address - Street 1:3808 PADRE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-7004
Practice Address - Country:US
Practice Address - Phone:956-761-3996
Practice Address - Fax:956-761-6635
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2011-10-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant