Provider Demographics
NPI:1629002928
Name:WILSON, ROBERT LEWIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:WILSON
Suffix:JR
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 11407 DEPT # 8094
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0001
Mailing Address - Country:US
Mailing Address - Phone:251-410-4001
Mailing Address - Fax:251-410-4002
Practice Address - Street 1:3715 DAUPHIN ST STE 7A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1775
Practice Address - Country:US
Practice Address - Phone:251-410-4001
Practice Address - Fax:251-410-4002
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23859208G00000X
ALMD42733208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3155481OtherBLUE CROSS PIN
TN3740051OtherUNITED HEALTHCARE
TN611133600OtherFEDERAL BLACK LUNG
TN3842696Medicaid
TN4128772OtherBCBS
TN4128772OtherBCBS
TN3842696Medicare PIN
F72370Medicare UPIN
TNF72370Medicare UPIN
TN611133600OtherFEDERAL BLACK LUNG
TNF72370Medicare UPIN