Individual
CARMEN R. WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H5145
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139450402
—
TX
05
—
139450403
—
TX
05
—
139450404
—
TX
05
—
139450406
—
TX
05
—
139450408
—
TX
05
—
139450409
—
TX
05
—
139450410
—
TX
05
—
139450411
—
TX
05
—
139450412
—
TX
05
—
139450414
—
TX
05
—
139450415
—
TX
05
—
139450416
—
TX
01
—
89G970
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/09/2005
Last updated
11/28/2012
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