Individual
DR. JON M WILSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
615 N ZARAGOZA RD, EL PASO, TX 79907-4773
(985) 867-0301
Mailing address
615 N ZARAGOZA RD, EL PASO, TX 79907-4773
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
3020
TX
213EP1101X
Primary Podiatric Medicine Podiatrist
DPM.200036
LA
213ES0000X
Sports Medicine Podiatrist
DPM.200036
LA
213ES0103X
Foot & Ankle Surgery Podiatrist
DPM.200036
LA
213ES0131X
Foot Surgery Podiatrist
DPM.200036
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DPM.200036
LA STATE LICENSE
LA
Enumeration date
01/22/2007
Last updated
06/10/2020
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