Provider Demographics
NPI:1801972385
Name:WILSON, ROBERT STOREY SR (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STOREY
Last Name:WILSON
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N MCCART ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2430
Mailing Address - Country:US
Mailing Address - Phone:254-968-2907
Mailing Address - Fax:
Practice Address - Street 1:1100 N MCCART ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-2430
Practice Address - Country:US
Practice Address - Phone:254-968-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE47702084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry