Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G45920 | CA |
N | 111NI0900X | Internist | G45920 | CA |
Y | 207RC0000X | Internist - Cardiovascular Disease | G45920 | CA |
NPI | 1013006212 |
---|---|
Provider Name | Dr. Reed Scott Wilson |
First Address | Beverly Hills, CA 90213-4919 |
Second Address | Beverly Hills, CA 90210-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 21/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92609 | (02) | CA |