Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 22817 | CO |
N | 2080P0207X | Pediatric Hematology-Oncologist | 94425 | NM |
N | 2080P0207X | Pediatric Hematology-Oncologist | J5061 | TX |
NPI | 1134180094 |
---|---|
Provider Name | Harry Lee Wilson |
First Address | El Paso, TX 79905-1613 |
Second Address | El Paso, TX 79902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117414601 | CIDC (01) | TX |
117414603 | (05) | TX |
F39326 | (02) | |
J5671 | (05) | NM |