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Individual

DR. DIANA ELIZABETH WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1001 12TH AVE STE 171, FORT WORTH, TX 76104-3926
(817) 576-6500
(682) 703-2064
Mailing address
1001 12TH AVE STE 171, FORT WORTH, TX 76104-3926
(817) 576-6500
(682) 703-2064

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
J0729
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
129595807
TX
05
162405801
TX
Enumeration date
08/25/2005
Last updated
02/10/2026
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