Individual
DR. PAMELA DOYLENE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6100 RICHMOND AVE STE 125, HOUSTON, TX 77057-6240
(713) 429-5919
(888) 572-8004
Mailing address
5535 MEMORIAL DRIVE, SUITE F-104, HOUSTON, TX 77007-8021
(713) 429-5919
(888) 572-8004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J8842
TX
207L00000X
Anesthesiology Physician
Primary
J8842
TX
208VP0014X
Interventional Pain Medicine Physician
J8842
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8AH490
BLUE CROSS BLUE SHIELD TEXAS
TX
Enumeration date
10/13/2005
Last updated
09/27/2018
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