Provider Demographics
NPI:1083619746
Name:WILSON, HUGH H JR (M D)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:H
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 GARY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6047
Mailing Address - Country:US
Mailing Address - Phone:806-687-5754
Mailing Address - Fax:806-385-4305
Practice Address - Street 1:10502 GARY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-6047
Practice Address - Country:US
Practice Address - Phone:806-687-5754
Practice Address - Fax:806-687-5754
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6212207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162693902Medicaid
TX162693901Medicaid
458836OtherMEDICARE RHC
TX019049801Medicaid
TX281971602Medicaid
TX162693901Medicaid
TX162693902Medicaid
TX671961Medicare Oscar/Certification