Individual
STEPHEN L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 S HENDERSON ST, FT WORTH, TX 76104-2924
(817) 870-1035
(817) 332-5005
Mailing address
1015 S HENDERSON ST, FT WORTH, TX 76104-2924
(817) 870-1035
(817) 332-5005
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MDG4220
TX
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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