Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R8134 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD60733507 | WA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | R8134 | TX |
NPI | 1114289022 |
---|---|
Provider Name | Travis J Wilson |
First Address | Round Rock, TX 78681-3573 |
Second Address | Round Rock, TX 78681-3573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2012 |
Last Update Date | 27/08/2018 |