Organization
EAST HOUSTON MEDICINE & PEDIATRICS CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORNELIUS ANTOINNE WILSON MD (OWNER PRESIDENT)
(713) 450-4455
Entity
Organization
Contact information
Practice address
12739 WOODFOREST BLVD STE 2, HOUSTON, TX 77015-2737
(713) 450-4455
(713) 450-4737
Mailing address
PO BOX 24308, HOUSTON, TX 77229-4308
(713) 450-4455
(713) 450-4737
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
J2845
TX
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0081QD
BLUE CROSS
TX
01
—
00L66J
BCBS
TX
05
—
184593501
—
TX
05
—
184593502
—
TX
01
—
45D1000292
CLIA
TX
Enumeration date
02/03/2006
Last updated
03/09/2026
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