1851316517 NPI number — LLOYD PAUL WILSON MD

Table of content: LLOYD PAUL WILSON MD (NPI 1851316517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851316517 NPI number — LLOYD PAUL WILSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
LLOYD
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
PAUL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851316517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-687-7134
Provider Business Mailing Address Fax Number:
541-687-7135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 HILYARD ST STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-8158
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-681-8586
Provider Business Practice Location Address Fax Number:
541-681-8587
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD11715 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8004138-01 . This is a "BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 8296717 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD5436R , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260828 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8005089-09 . This is a "BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: MD5435R , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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