Provider Demographics
NPI:1417933680
Name:WILSON, JOE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:B
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 BINZ ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6900
Mailing Address - Country:US
Mailing Address - Phone:713-797-9191
Mailing Address - Fax:713-394-2852
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-797-9191
Practice Address - Fax:713-394-2852
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXC91862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX820034Medicare ID - Type Unspecified
TXC23645Medicare UPIN