Individual
DR. JASON DAVID WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4410 MEDICAL DR STE 320, SAN ANTONIO, TX 78229-3749
(210) 874-3270
Mailing address
4410 MEDICAL DR STE 320, SAN ANTONIO, TX 78229-3749
(210) 874-3270
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
205122
LA
207T00000X
Neurological Surgery Physician
Primary
S9627
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128732
—
AL
01
—
1M8463
MEDICARE
TX
05
—
200974460
—
IN
05
—
2183559
—
LA
01
—
51115470
BLUE CROSS
AL
Enumeration date
11/28/2006
Last updated
03/16/2021
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