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Individual
JOHN M. WILSON
Active
Individual
JOHN M. 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
G6425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110186000
RAILROAD MEDICARE
TX
05
—
140177012
—
TX
05
—
140177013
—
TX
05
—
140177015
—
TX
05
—
140177016
—
TX
05
—
140177019
—
TX
05
—
140177020
—
TX
05
—
140177021
—
TX
05
—
140177022
—
TX
05
—
140177023
—
TX
05
—
140177024
—
TX
05
—
140177025
—
TX
01
—
87W582
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/08/2005
Last updated
11/10/2012
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