MEDICARE: DR. PATRICK HENRY WILSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	F2500	TX

General Provider Information

NPI Number	:	1578590238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK HENRY WILSON M.D.

Provider Business Mailing Address
First Line	:	6200 UTSA BLVD
Second Line	:	100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1617
Country	:	US
Telephone Number	:	210-614-8200
Fax Number	:	210-614-8258

Provider Business Practice Location Address
First Line	:	6200 UTSA BLVD
Second Line	:	100
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1617
Country	:	US
Telephone Number	:	210-614-8200
Fax Number	:	210-614-8258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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