Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D6212 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | D6212 | TX |
NPI | 1083619746 |
---|---|
Provider Name | Hugh H Wilson JR. |
First Address | Lubbock, TX 79423-6047 |
Second Address | Lubbock, TX 79423-6047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019049801 | (05) | TX |
162693901 | (05) | TX |
162693902 | (05) | TX |
281971602 | (05) | TX |
458836 | MEDICARE RHC (01) | |
C23640 | (02) | TX |