Provider Demographics
NPI:1740868256
Name:WILSON, ROBERT RUSSELL ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RUSSELL ALEXANDER
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7838 HUEBNER RD APT 3303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-6125
Mailing Address - Country:US
Mailing Address - Phone:864-419-9050
Mailing Address - Fax:
Practice Address - Street 1:7979 WURZBACH RD # MC7889
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:864-419-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7445092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology