Wilson, Russell L.

Wilson, Russell L. is an individual health care provider with primary practice located at 1215 Duff Ave , Ames IA 50010-3014. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wilson, Russell L. can be contacted via phone (515) 239-4456.

Contact Information

Primary practice address
1215 Duff Ave Ames IA 50010-3014
Phone: (515) 239-4456
Fax: (515) 239-4761
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 23024 Iowa

Profile Details

NPI number 1487636627
LBN Legal business name Wilson, Russell L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2005
Last updated Sep 12th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487636627 NPPES
Iowa MEDICAID 0196311

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