Individual
JOHN D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1750 NORTH HAMPTON ROAD, DESOTO, TX 75115
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J7730
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041641402
—
TX
05
—
041641403
—
TX
Enumeration date
11/30/2005
Last updated
06/22/2018
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