Individual
DAVID BRADFORD WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA, CST/CFA
Contact information
Practice address
5016 RIVER BLUFF DR, FORT WORTH, TX 76132-3710
(817) 800-8386
(817) 295-4992
Mailing address
PO BOX 33394, FORT WORTH, TX 76162-3394
(817) 800-8386
(817) 295-4992
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA0007
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8N4608
BCBS OF TX
TX
Enumeration date
08/13/2006
Last updated
07/08/2007
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