Provider Demographics
NPI:1972591139
Name:WILSON, DORIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 MT VIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-4410
Mailing Address - Country:US
Mailing Address - Phone:360-426-2653
Mailing Address - Fax:360-427-7086
Practice Address - Street 1:939 MT VIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-4410
Practice Address - Country:US
Practice Address - Phone:360-426-2653
Practice Address - Fax:360-427-7086
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine