Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD00030372 | WA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD00030372 | WA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | MD00030372 | WA |
NPI | 1164456471 |
---|---|
Provider Name | Frederic Barlow Wilson I |
First Address | Coupeville, WA 98239-9500 |
Second Address | Coupeville, WA 98239-9500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2049935 | (05) | WA |