Individual
TODD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6410 FANNIN ST, 1400, HOUSTON, TX 77030-3000
(832) 325-7125
Mailing address
PO BOX 201088, HOUSTON, TX 77216-1088
(713) 500-3500
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
N1226
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199169701
—
TX
01
—
8AN624
BCBS
TX
Enumeration date
09/08/2008
Last updated
03/19/2009
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