Provider Demographics
NPI:1598055378
Name:HUGH H WILSON JR, M.D., P. A.
Entity Type:Organization
Organization Name:HUGH H WILSON JR, M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:806-687-5754
Mailing Address - Street 1:10502 GARY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6047
Mailing Address - Country:US
Mailing Address - Phone:806-687-5754
Mailing Address - Fax:806-385-4305
Practice Address - Street 1:1600 S SUNSET AVE
Practice Address - Street 2:
Practice Address - City:LITTLEFIELD
Practice Address - State:TX
Practice Address - Zip Code:79339-4810
Practice Address - Country:US
Practice Address - Phone:806-385-6424
Practice Address - Fax:806-385-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K1510OtherBLUE CROSS BLUE SHIELD INDIVIDUAL
TX110413513Medicaid
TX110413512Medicaid
TX110413510Medicaid
TX0005KPOtherBLUE CROSS BLUE SHIELD GROUP
C23640Medicare UPIN
TXTXB129197Medicare PIN
TX110413512Medicaid