Provider Demographics
NPI:1831167006
Name:WILSON, STEVEN J (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1767
Mailing Address - Country:US
Mailing Address - Phone:940-689-9664
Mailing Address - Fax:940-689-9662
Practice Address - Street 1:1 W MEDICAL CT
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1767
Practice Address - Country:US
Practice Address - Phone:940-689-9664
Practice Address - Fax:940-689-9662
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDJ6814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B5610OtherBLUE CROSS BLUE SHIELD
TX8B5610OtherBLUE CROSS BLUE SHIELD
TXG02737Medicare UPIN
TX8140N0Medicare PIN