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General NPI Number Information
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NPI Number | 1760470439
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Entity Type | Individual
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Provider Name | THOMAS LAURENCE WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 2602 SAINT MICHAEL DR SUITE 201A
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City | TEXARKANA
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State | TX
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Zip | 75503-2387
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Country | US
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Telephone | 903-792-1216
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Fax | 903-614-5299
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Provider Business Mailing Address
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Address Line | 2602 SAINT MICHAEL DR STE 201A
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City | TEXARKANA
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State | TX
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Zip | 75503-2387
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Country | US
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Telephone | 903-792-1216
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Fax | 903-614-5299
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G7024
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License Number State | TX
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