Individual
THOMAS LAURENCE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2602 SAINT MICHAEL DR, SUITE 201A, TEXARKANA, TX 75503-2387
(903) 792-1216
(903) 614-5299
Mailing address
2602 SAINT MICHAEL DR STE 201A, TEXARKANA, TX 75503-2387
(903) 792-1216
(903) 614-5299
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G7024
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00DF12
BC/BS
TX
05
—
097982501
—
TX
05
—
11368001
—
AR
01
—
89358
BLUE CROSS
AR
Enumeration date
10/07/2005
Last updated
01/09/2026
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