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General NPI Number Information
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NPI Number | 1215197090
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Entity Type | Organization
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Legal Business Name | JOHN W WILSON D O P A
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Dates
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Enumeration Date | 06/14/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 2011 N COLLINS BLVD 609
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City | RICHARDSON
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State | TX
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Zip | 75080-2645
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Country | US
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Telephone | 972-889-1194
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Fax | 972-889-1425
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Provider Business Mailing Address
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Address Line | 2011 N COLLINS BLVD 609
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City | RICHARDSON
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State | TX
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Zip | 75080-2645
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Country | US
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Telephone | 972-889-1194
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Fax | 972-889-1425
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN W WILSON
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Credential | DO
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Telephone | 972-889-1194
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E6952
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License Number State | TX
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