MEDICARE: LONTRICIA WILSON MD

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	207R00000X	Internal Medicine Physician	U9691	TX

General Provider Information

NPI Number	:	1982231114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONTRICIA WILSON MD

Provider Business Mailing Address
First Line	:	1717 MONTCLAIR DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-1905
Country	:	US
Telephone Number	:	817-806-8273
Fax Number	:

Provider Business Practice Location Address
First Line	:	454 N JIM WRIGHT FWY
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-1437
Country	:	US
Telephone Number	:	682-703-4505
Fax Number	:	682-703-4510

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

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	04/29/2026

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