MEDICARE: DR. PAMELA DOYLENE 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
1	174400000X	Specialist	J8842	TX
2	208VP0014X	Interventional Pain Medicine Physician	J8842	TX
3	207L00000X	Anesthesiology Physician	J8842	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AH490	OTHER	TX	BLUE CROSS BLUE SHIELD TEXAS

General Provider Information

NPI Number	:	1528056553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA DOYLENE WILSON M.D.

Provider Business Mailing Address
First Line	:	5535 MEMORIAL DRIVE
Second Line	:	SUITE F-104
City	:	HOUSTON
State	:	TX
Zip	:	77007-8021
Country	:	US
Telephone Number	:	713-429-5919
Fax Number	:	888-572-8004

Provider Business Practice Location Address
First Line	:	6100 RICHMOND AVE STE 125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-6240
Country	:	US
Telephone Number	:	713-429-5919
Fax Number	:	888-572-8004

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/27/2018

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