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
Phone: (817) 441-1441
Fax: (817) 441-1443
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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