Individual
DR. COURTNEY WILEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7777 FOREST LN, DALLAS, TX 75230-2505
(972) 566-2667
Mailing address
PO BOX 201606, DALLAS, TX 75320-1606
(972) 758-3598
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M2870
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178854901
—
TX
05
—
178854902
—
TX
01
—
8S2688
BCBS
TX
01
—
P00367554
MEDICARE RAILROAD
TX
Enumeration date
05/19/2006
Last updated
12/01/2009
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