Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | K2387 | TX |
NPI | 1821050600 |
---|---|
Provider Name | Philip L Wilson |
First Address | Dallas, TX 75219-3924 |
Second Address | Frisco, TX 75034-9580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 12/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158913701 | (05) | TX |
H61132 | (02) |