Individual
DR. CHARLES R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
327 MORRIS RD W, SOUR LAKE, TX 77659-9774
(409) 753-2577
Mailing address
327 MORRIS RD W, SOUR LAKE, TX 77659-9774
(409) 753-2577
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H8516
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139218516
—
TX
Enumeration date
07/27/2006
Last updated
05/01/2013
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