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1780669325

NPI Code Detail

MEDICARE: LAURA JEAN WILNER MD

MEDICARE: LAURA JEAN WILNER MD

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	51885	AZ
2	2081P0010X	Pediatric Rehabilitation Medicine Physician	ME111475	FL
3	2081P0010X	Pediatric Rehabilitation Medicine Physician	U9187	TX
4	208000000X	Pediatrics Physician	U9187	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	FW586Z	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780669325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN WILNER MD

Provider Business Mailing Address
First Line	:	315 N SAN SABA STE 1135
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3255
Country	:	US
Telephone Number	:	210-704-4275
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 N SANTA ROSA
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3108
Country	:	US
Telephone Number	:	210-704-3030
Fax Number	:

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	03/08/2024

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Directions to “ LAURA JEAN WILNER MD” Practice Location

Language	Start Address	Practice Location

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