Individual
BILLY RAY WILSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
902 W BLAIR AVE, COALGATE, OK 74538-1206
(580) 927-5588
Mailing address
902 W BLAIR AVE, COALGATE, OK 74538-1206
(580) 927-5588
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/03/2022
Last updated
03/03/2022
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