Provider Demographics
NPI:1194827337
Name:WILSON, JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 1630
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2734
Mailing Address - Country:US
Mailing Address - Phone:832-336-1530
Mailing Address - Fax:713-790-1605
Practice Address - Street 1:6560 FANNIN ST STE 1630
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2734
Practice Address - Country:US
Practice Address - Phone:832-336-1530
Practice Address - Fax:713-790-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5062207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060042185OtherMCR RAILROAD
TX124671203Medicaid
TX5907011OtherAETNA
TX82500FOtherBCBS
TX82500FOtherBCBS
TX124671203Medicaid