Provider Demographics
NPI:1457612749
Name:WILSON, JANICE MAY (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0783
Mailing Address - Country:US
Mailing Address - Phone:409-772-1911
Mailing Address - Fax:409-772-4456
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:UNIVERSITY OF TEXAS MEDICAL BRANCH-DERMATOLOGY
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0783
Practice Address - Country:US
Practice Address - Phone:409-772-1911
Practice Address - Fax:409-772-4456
Is Sole Proprietor?:No
Enumeration Date:2012-06-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5126207ND0900X
TXBP10044148207R00000X
TXBP20046284207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine