MEDICARE: DR. WESLEY GARRETT WILSON DO

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	J3393	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WESLEY GARRETT WILSON DO

Provider Business Mailing Address
First Line	:	605 E BROAD ST
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-4116
Country	:	US
Telephone Number	:	469-720-4490
Fax Number	:	833-450-4889

Provider Business Practice Location Address
First Line	:	605 E BROAD ST
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-4116
Country	:	US
Telephone Number	:	469-720-4490
Fax Number	:	833-450-4889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/26/2024

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