DR. JOHNNY M WILSON M.D. NPI 1114910080

NPI Information

NPI: 1114910080
Provider Name: DR. JOHNNY M WILSON, M.D.
Classification: Family Medicine - 207Q00000X
Entity Type: Individual
Address:
136 EL CHICO TRL
SUITE 103
WILLOW PARK, TX
ZIP 76087
Phone: (817) 441-1441
Get Directions

DR. Johnny M Wilson, M.D. is a family medicine in Willow Park, TX. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Johnny M Wilson, M.D. NPI is 1114910080. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

136 EL CHICO TRL
SUITE 103
WILLOW PARK, TX
ZIP 76087-863
Phone: (817) 441-1441
Fax: (817) 441-1443

The enumeration date for this NPI number is 8/25/2005 and was last updated on 3/29/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine		L4177	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	L4177	OTHER	TEXAS	UNICARE
2	0082174	OTHER	TEXAS	BLUE LINK
3	8L23343	MEDICARE PIN	TEXAS
4	WILJC67146	OTHER	TEXAS	CHIP HEALTHPLAN
5	C67146	MEDICARE UPIN	TEXAS
6	0072KC	OTHER	TEXAS	BLUE CROSS BLUE SHIELD
7	7111148	OTHER	TEXAS	AETNA/TRS COORDINATED CAR
8	1164502	OTHER	TEXAS	AFFILIATED HEALTHCARE
9	1354278	OTHER	TEXAS	FOCUS
10	158350201	MEDICAID	TEXAS
11	158350203	MEDICAID	TEXAS
12	00769H	MEDICARE PIN	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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