Provider Demographics
NPI:1407524135
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:940-665-0701
Mailing Address - Street 1:1379 FM 678
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-7546
Mailing Address - Country:US
Mailing Address - Phone:940-665-0701
Mailing Address - Fax:940-665-3959
Practice Address - Street 1:1379 FM 678
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-7546
Practice Address - Country:US
Practice Address - Phone:940-665-0701
Practice Address - Fax:940-665-3959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty