Provider Demographics
NPI:1104098185
Name:WILSON, CHRISTOPHER ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST
Practice Address - Street 2:SUITE 400
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1262
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-2888
Is Sole Proprietor?:No
Enumeration Date:2008-03-30
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV15188207RC0000X, 207RC0000X
CT#CSP.0042392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA123086Medicare PIN
NVV107775Medicare PIN
NVV108000Medicare PIN
CACA123087Medicare PIN