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General NPI Number Information
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NPI Number | 1184051906
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Entity Type | Individual
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Provider Name | DAVID GEORGE WILSON MPO, CP, LP
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Gender | Male
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Dates
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Enumeration Date | 10/11/2013
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 6011 HARRY HINES BLVD SUITE V2.302
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City | DALLAS
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State | TX
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Zip | 75390-9091
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Country | US
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Telephone | 214-645-8254
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Fax | 214-645-8258
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Provider Business Mailing Address
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Address Line | 6011 HARRY HINES BLVD SUITE V5.400
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City | DALLAS
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State | TX
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Zip | 75390-9091
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Country | US
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Telephone | 214-645-8254
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Fax | 214-645-8258
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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 | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 1625
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License Number State | TX
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