Dr. Robert S. Wildin
Clinical Genetics (M.D.)
190 E Bannock St St. Luke's Children's Specialty Ctr (csc Suite 200)
Boise
, Idaho 83712-6241
Dr. Robert S. Wildin
Clinical Genetics (M.D.)
190 E Bannock St St. Luke's Children's Specialty Ctr (csc Suite 200)
Boise
, Idaho 83712-6241
(503) 768-9547
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About
Features
Specialties
- Clinical Genetics (M.D.)
Languages spoken
- English
Location
First Address
- Dr. Robert S. Wildin
- 6140 Sw 41st Ave
- Portland, OR
- Zip : 97221-3344
- Fax : (503) 768-9547
- Phone : (503) 768-9547
Second Address
- Dr. Robert S. Wildin
- 190 E Bannock St St. Luke's Children's Specialty Ctr (csc Suite 200)
- Boise, ID
- Zip : 83712-6241
- Fax : (208) 381-6186
- Phone : (208) 381-7339
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207SG0201X | Clinical Genetics (M.D.) | M8801 | ID |
| N | 207SG0201X | Clinical Genetics (M.D.) | MD20420 | OR |
National Provider Identifier
| NPI | 1073586897 |
|---|---|
| Provider Name | Dr. Robert S. Wildin |
| First Address | Portland, OR 97221-3344 |
| Second Address | Boise, ID 83712-6241 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 10/02/2006 |
| Last Update Date | 29/01/2014 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 002823400 | (05) | ID |
| 085514 | (05) | OR |
| 8140428 | (05) | WA |
| F34423 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.