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NPI Code Detail

MEDICARE: MR. MICHAEL RAY WILSON

MEDICARE: MR. MICHAEL RAY WILSON
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
1247200000XOther Technician

General Provider Information

NPI Number : 1932200359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL RAY WILSON
Provider Business Mailing Address
First Line : 4038 TEAL RUN PLACE CT
Second Line :
City : FRESNO
State : TX
Zip : 77545-7055
Country : US
Telephone Number : 281-431-5827
Fax Number :
Provider Business Practice Location Address
First Line : 2002 HOLCOMBE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77030-4211
Country : US
Telephone Number : 713-791-1414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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Directions to “ MR. MICHAEL RAY WILSON ” Practice Location

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