Provider Demographics
NPI:1780646760
Name:WILSON, BARBARA JANE (MD,FACS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD,FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1723
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2723
Mailing Address - Country:US
Mailing Address - Phone:832-530-4081
Mailing Address - Fax:832-530-4082
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 1723
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2723
Practice Address - Country:US
Practice Address - Phone:832-530-4081
Practice Address - Fax:832-530-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400283208600000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA020001552Medicare UPIN