Healthcare Provider Details

I. General information

NPI: 1124656541
Provider Name (Legal Business Name): BRANDEN CARL WILSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E PFLUGERVILLE PKWY STE 200
PFLUGERVILLE TX
78660-5999
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 512-654-6500
  • Fax:
Mailing address:
  • Phone: 800-994-0371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU4964
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU4964
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberU4964
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: