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Organization
NACOGDOCHES INTERNAL MEDICINE PLLC
Active
Organization
NACOGDOCHES INTERNAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER BRAD WILSON M.D. (PRESIDENT)
(936) 560-1812
Entity
Organization
Contact information
Practice address
412 NORTH ST STE E, NACOGDOCHES, TX 75961
(936) 560-1812
(936) 560-3070
Mailing address
412 NORTH ST STE E, NACOGDOCHES, TX 75961-5070
(936) 560-1812
(936) 560-3070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
H3293
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113906502
—
TX
05
—
377530601
—
TX
Enumeration date
11/28/2016
Last updated
05/21/2018
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