Provider Demographics
NPI:1467868083
Name:WILSON, PERCY III
Entity Type:Individual
Prefix:MR
First Name:PERCY
Middle Name:
Last Name:WILSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 WESTHEIMER RD
Mailing Address - Street 2:619
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5641
Mailing Address - Country:US
Mailing Address - Phone:281-905-4224
Mailing Address - Fax:
Practice Address - Street 1:5868 WESTHEIMER RD
Practice Address - Street 2:619
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5641
Practice Address - Country:US
Practice Address - Phone:281-905-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies