Provider Demographics
NPI:1205931136
Name:WILSON, BILLY HERBERT (MD)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:HERBERT
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4315 28TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-792-2104
Mailing Address - Fax:806-792-2134
Practice Address - Street 1:4315 28TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-792-2104
Practice Address - Fax:806-792-2134
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5582207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3781OtherBLUE CROSS
D69284Medicare UPIN
TX8H3781OtherBLUE CROSS