Healthcare Provider Details

I. General information

NPI: 1831167006
Provider Name (Legal Business Name): STEVEN J WILSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

IV. Provider business mailing address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

V. Phone/Fax

Practice location:
  • Phone: 940-689-9664
  • Fax: 940-689-9662
Mailing address:
  • Phone: 940-689-9664
  • Fax: 940-689-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMDJ6814
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: