Provider Demographics
NPI:1952615288
Name:WILSON, STEVEN GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GERARD
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2377 N STEMMONS FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2710
Mailing Address - Country:US
Mailing Address - Phone:214-819-2199
Mailing Address - Fax:214-819-2107
Practice Address - Street 1:2377 N STEMMONS FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2710
Practice Address - Country:US
Practice Address - Phone:214-819-2199
Practice Address - Fax:214-819-2107
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH85192083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine