Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10368 | TX |
Y | 213EG0000X | General Practice | 10368 | TX |
NPI | 1003811936 |
---|---|
Provider Name | Dr. Frank Wayne Wilson |
First Address | Arlington, TX 76013-2537 |
Second Address | Arlington, TX 76013-2537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/07/2007 |