Provider Demographics
NPI:1457326423
Name:WILSON, WAYNE BURLESON (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:BURLESON
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 1:222 E RIDGE RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1251
Mailing Address - Country:US
Mailing Address - Phone:956-686-6588
Mailing Address - Fax:956-682-0759
Practice Address - Street 1:222 E RIDGE RD
Practice Address - Street 2:SUITE 216
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1251
Practice Address - Country:US
Practice Address - Phone:956-686-6588
Practice Address - Fax:956-682-0759
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7315207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129596601Medicaid
TX828696Medicare ID - Type Unspecified
TX129596601Medicaid