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Individual
RICHARD D WILSON
Active
Individual
RICHARD D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G3095
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00064CV
BCBS
—
05
—
079972801
—
TX
01
—
110162071
MCR RR
—
01
—
75-2616977-042
TRICARE
TX
01
—
8EJ819
BCBS
TX
Enumeration date
08/09/2005
Last updated
06/12/2014
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