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General NPI Number Information
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NPI Number | 1528096815
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Entity Type | Individual
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Provider Name | RONALD THOMAS WILSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | 2548 LILLIAN MILLER PKWY SUITE 110
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City | DENTON
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State | TX
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Zip | 76210-7212
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Country | US
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Telephone | 940-383-5963
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Fax | 940-382-3330
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Provider Business Mailing Address
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Address Line | 2548 LILLIAN MILLER PKWY SUITE 110
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City | DENTON
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State | TX
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Zip | 76210-7212
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Country | US
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Telephone | 940-383-5963
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Fax | 940-382-3330
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | F6173
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License Number State | TX
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