Provider Demographics
NPI:1801848312
Name:WILSON, DAN E JR (DO)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:E
Last Name:WILSON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:425 HOLDERRIETH BLVD
Mailing Address - Street 2:SUITE206
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4543
Mailing Address - Country:US
Mailing Address - Phone:281-357-5454
Mailing Address - Fax:281-357-5499
Practice Address - Street 1:425 HOLDERRIETH BLVD
Practice Address - Street 2:SUITE206
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4543
Practice Address - Country:US
Practice Address - Phone:281-357-5454
Practice Address - Fax:281-357-5499
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK-6414208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148843003Medicaid
AR148843003Medicaid