Wilson, Johnny M

Wilson, Johnny M is an individual health care provider with primary practice located at 136 El Chico Trl Suite 103, Willow Park TX 76087-8863. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wilson, Johnny M can be contacted via phone (817) 441-1441.

Contact Information

Primary practice address
136 El Chico Trl Suite 103 Willow Park TX 76087-8863
Fax: (817) 441-1443
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X L4177 Texas

Profile Details

NPI number 1114910080
LBN Legal business name Wilson, Johnny M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 25th, 2005
Last updated Mar 29th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114910080 NPPES
Texas Other 1164502 AFFILIATED HEALTHCARE
Texas Other L4177 AFFILIATED HEALTHCARE
Texas Other 0072KC AFFILIATED HEALTHCARE
Texas Other 0082174 AFFILIATED HEALTHCARE
Texas Other 1354278 AFFILIATED HEALTHCARE
Texas Other 7111148 AFFILIATED HEALTHCARE
Texas MEDICAID 158350203 AFFILIATED HEALTHCARE
Texas MEDICAID 158350201 AFFILIATED HEALTHCARE
Texas Other WILJC67146 AFFILIATED HEALTHCARE

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