Provider Demographics
NPI:1962473496
Name:WILSON, ROBERT BRUCE II (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:WILSON
Suffix:II
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 1:320 JAKE ALEXANDER BLVD W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-1442
Mailing Address - Country:US
Mailing Address - Phone:704-797-0065
Mailing Address - Fax:704-797-0067
Practice Address - Street 1:320 JAKE ALEXANDER BLVD W
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1442
Practice Address - Country:US
Practice Address - Phone:704-797-0065
Practice Address - Fax:704-797-0067
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601527207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891269VMedicaid
NC2280967AMedicare ID - Type Unspecified
NCH22999Medicare UPIN