Individual
MR. JUSTIN ALAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OPA-C
Contact information
Practice address
16020 PARK VALLEY DR, ROUND ROCK, TX 78681-3573
(512) 477-6341
(512) 477-1959
Mailing address
7208 HARDY DR, AUSTIN, TX 78757-2207
(512) 656-6143
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
913
—
246ZS0410X
Surgical Technologist
913
—
246ZX2200X
Orthopedic Assistant
Primary
913
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#913
ORTHOPEDIC PHYSICIAN ASSISTANTS
—
Enumeration date
04/20/2015
Last updated
01/19/2022
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