Organization
NEUROSURGICAL AND SPINE CONSULTANTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA E WILSON M.D. (OWNER/PHYSCIAN)
(817) 576-6500
Entity
Organization
Contact information
Practice address
1001 12TH AVE, STE 170, FT WORTH, TX 76104-3926
(214) 373-3183
(214) 361-5601
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
174400000X
Specialist
Primary
J0729
TX
Other
Enumeration date
03/12/2015
Last updated
01/02/2019
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