MEDICARE: UNIVERSITY OF TEXAS MEDICAL BRANCH

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1407524135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF TEXAS MEDICAL BRANCH

Provider Business Mailing Address
First Line	:	1379 FM 678
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-7546
Country	:	US
Telephone Number	:	940-665-0701
Fax Number	:	940-665-3959

Provider Business Practice Location Address
First Line	:	1379 FM 678
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-7546
Country	:	US
Telephone Number	:	940-665-0701
Fax Number	:	940-665-3959

Authorized Official
Title or Position	:	PROVIDER
Name	:	MRS. LINDA MARIE WILSON
Credential	:	FNP-BC
Telephone Number	:	940-665-0701

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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Directions to “UNIVERSITY OF TEXAS MEDICAL BRANCH ” Practice Location

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