Individual
DANIEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11937 US HIGHWAY 271, TYLER, TX 75708-3154
(903) 877-7200
Mailing address
504 RAVENWOOD DR, ATHENS, TX 75751-3124
(940) 585-8097
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
W1920
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/28/2024
Last updated
03/16/2026
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