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Individual
DR. JOHNNY M WILSON
Active
Individual
DR. JOHNNY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L4177
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0072KC
BLUE CROSS BLUE SHIELD
TX
01
—
0082174
BLUE LINK
TX
01
—
1164502
AFFILIATED HEALTHCARE
TX
01
—
1354278
FOCUS
TX
05
—
158350201
—
TX
05
—
158350203
—
TX
01
—
7111148
AETNA/TRS COORDINATED CAR
TX
01
—
L4177
UNICARE
TX
01
—
WILJC67146
CHIP HEALTHPLAN
TX
Enumeration date
08/25/2005
Last updated
03/29/2010
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