Individual
BRIAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
116 ALABAMA ST, DALHART, TX 79022-5334
(806) 244-2266
(806) 244-7266
Mailing address
PO BOX 1179, DALHART, TX 79022-1179
(806) 244-2266
(806) 244-7266
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
0013033
TX
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0029692
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016110101
—
TX
05
—
1457780-01
—
TX
01
—
515744
BLUE CROSS BLUE SHILED
TX
Enumeration date
07/14/2008
Last updated
11/02/2008
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