Individual
LESLIE E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
129 VISION PARK BLVD STE 206, SHENANDOAH, TX 77384-3024
(281) 315-8130
(281) 315-8131
Mailing address
129 VISION PARK BLVD STE 206, SHENANDOAH, TX 77384-3024
(281) 315-8130
(281) 315-8131
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
L6721
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159231303
—
TX
01
—
536411YP67
PTAN
TX
01
—
8HA973
BCBS RECORD ID
—
Enumeration date
02/15/2006
Last updated
03/03/2026
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