| Entity Name: | ROBERT W. WILSON, D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Oct 1999 (25 years ago) |
| Date of dissolution: | 27 Dec 2022 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Dec 2022 (2 years ago) |
| Document Number: | P99000091077 |
| FEI/EIN Number | 650955495 |
| Address: | 2940 IMMOKALEE ROAD, SUITE 2, NAPLES, FL, 34110 |
| Mail Address: | 9125 The Lane, Naples, FL, 34109, US |
| ZIP code: | 34110 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841415932 | 2007-04-16 | 2020-08-22 | 2940 IMMOKALEE RD, SUITE #2, NAPLES, FL, 341101409, US | 2940 IMMOKALEE RD, SUITE #2, NAPLES, FL, 341101409, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-598-5750 |
Authorized person
| Name | DR. ROBERT WILCOX WILSON |
| Role | OWNER |
| Phone | 2395985750 |
Taxonomy
| Taxonomy Code | 2080A0000X - Pediatric Adolescent Medicine Physician |
| License Number | 0S0006131 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 80906 |
| Issuer | FL HEALTHY KIDS |
| Number | 202096 |
| State | FL |
| Issuer | GREAT WEST |
| Number | 435695 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT W. WILSON D.O. P.A. RETIREMENT SAVINGS PLAN | 2009 | 650955495 | 2010-06-17 | ROBERT W. WILSON D.O. P.A. | 10 | |||||||||||||||||||||||||||||||||||||||||
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| Administrator’s EIN | 650955495 |
| Plan administrator’s name | ROBERT W. WILSON D.O. P.A. |
| Plan administrator’s address | 2940 IMMOKALEE RD. SUITE 2, NAPLES, FL, 34110 |
| Administrator’s telephone number | 2395985750 |
Signature of
| Role | Plan administrator |
| Date | 2010-06-17 |
| Name of individual signing | ROBERT WILSON |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2010-06-17 |
| Name of individual signing | ROBERT WILSON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| WILSON ROBERT W | Agent | 9125 The Lane, Naples, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| WILSON ROBERT W | Director | 9125 THE LANE, NAPLES, FL, 34109 |
| Name | Role | Address |
|---|---|---|
| NAJM-MASOUD SOBIA D | Secretary | 2940 IMMOKALEE RD #2, NAPLES, FL, 34110 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000023623 | WILSON PEDIATRICS | ACTIVE | 2016-03-04 | 2026-12-31 | No data | 9125 THE LANE, #2, NAPLES, FL, 34109 |
| G10000096701 | WILSON PEDIATRICS | EXPIRED | 2010-10-21 | 2015-12-31 | No data | 2940 IMMOKALEE RD, #2, NAPLES, FL, 34110 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-12-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-07 | 2940 IMMOKALEE ROAD, SUITE 2, NAPLES, FL 34110 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-07 | 9125 The Lane, Naples, FL 34109 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-02-07 | WILSON, ROBERT W | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-09-20 | 2940 IMMOKALEE ROAD, SUITE 2, NAPLES, FL 34110 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-12-27 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-01-11 |
| AMENDED ANNUAL REPORT | 2020-02-27 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-02-04 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
