Individual
AMY JO WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
909 N WASHINGTON AVE, DALLAS, TX 75246-1520
(214) 820-9637
(214) 820-9339
Mailing address
909 N WASHINGTON AVE, DALLAS, TX 75246-1520
(214) 820-9637
(214) 820-9339
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J4616
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
047992501
—
TX
05
—
047992502
—
TX
05
—
047992503
—
TX
05
—
047992504
—
TX
01
—
8BR154
BCBS
TX
Enumeration date
08/05/2006
Last updated
11/15/2022
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