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General NPI Number Information
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NPI Number | 1023269172
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Entity Type | Individual
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Provider Name | JAMES MICHAEL WILSON MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 800 E DAWSON ST
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City | TYLER
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State | TX
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Zip | 75701-2036
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Country | US
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Telephone | 903-525-1914
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846098
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City | DALLAS
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State | TX
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Zip | 75284-6098
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Country | US
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Telephone | 903-606-6400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 7150810-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N8874
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License Number State | TX
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