Healthcare Provider Details

I. General information

NPI: 1194827337
Provider Name (Legal Business Name): JAMES WILSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SUNSET BLVD
HOUSTON TX
77005-1798
US

IV. Provider business mailing address

1701 SUNSET BLVD
HOUSTON TX
77005-1798
US

V. Phone/Fax

Practice location:
  • Phone: 713-526-5511
  • Fax:
Mailing address:
  • Phone: 713-520-4713
  • Fax: 713-520-4755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberJ5062
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberJ5062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: