Individual
DR. BENJAMIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
OS018849
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
T3215
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/01/2011
Last updated
02/22/2022
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