| John W Wilson DO PA | |
|
2011 N Collins Blvd 609 Richardson TX 75080-2645 | |
| (972) 889-1194 | |
| (972) 889-1425 |
| Full Name | John W Wilson DO PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 2011 N Collins Blvd, Richardson, Texas |
| Authorized Official Name and Position | John W Wilson (PHYSICIAN) |
| Authorized Official Contact | 9728891194 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John W Wilson DO PA 2011 N Collins Blvd 609 Richardson TX 75080-2645 Ph: (972) 889-1194 | John W Wilson DO PA 2011 N Collins Blvd 609 Richardson TX 75080-2645 Ph: (972) 889-1194 |
| NPI Number | 1215197090 |
|---|---|
| Provider Enumeration Date | 06/14/2008 |
| Last Update Date | 11/13/2008 |
| Medicare PECOS PAC ID | 0244301125 |
|---|---|
| Medicare Enrollment ID | O20080620000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215197090 | NPI | - | NPPES |
| 195978501 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | E6952 (Texas) | Primary |
| Provider Name | John W Wilson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801854757 PECOS PAC ID: 5597662965 Enrollment ID: I20031215000395 |
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