Individual
DR. MARK S WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11212 STATE HIGHWAY 151, SAN ANTONIO, TX 78251-4498
(361) 985-1221
Mailing address
PO BOX 6696, CORPUS CHRISTI, TX 78466-6696
(361) 985-1221
(361) 985-1295
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
L5615
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154048603
—
TX
Enumeration date
10/11/2006
Last updated
08/30/2022
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