Healthcare Provider Details

I. General information

NPI: 1780971549
Provider Name (Legal Business Name): UROLOGY CLINICS OF NORTH TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 LANCASTER DR STE 350
GRAPEVINE TX
76051-3599
US

IV. Provider business mailing address

1650 REPUBLIC PKWY STE 130
MESQUITE TX
75150-6920
US

V. Phone/Fax

Practice location:
  • Phone: 214-915-8502
  • Fax: 682-223-5006
Mailing address:
  • Phone: 214-692-8262
  • Fax: 214-696-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateTX

VIII. Authorized Official

Name: JERRI D WILSON
Title or Position: CEO
Credential:
Phone: 214-691-1902