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NPI Code Detail

MEDICARE: AMY JO WILSON M.D.

MEDICARE: AMY JO WILSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation PhysicianJ4616TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
58BR154OTHERTXBCBS

General Provider Information

NPI Number : 1235148677
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JO WILSON M.D.
Provider Business Mailing Address
First Line : 909 N WASHINGTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75246-1520
Country : US
Telephone Number : 214-820-9637
Fax Number : 214-820-9339
Provider Business Practice Location Address
First Line : 909 N WASHINGTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75246-1520
Country : US
Telephone Number : 214-820-9637
Fax Number : 214-820-9339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 11/15/2022

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