Provider Demographics
NPI:1063420271
Name:ALLIANCE OB GYN SPECIALISTS PLLC
Entity type:Organization
Organization Name:ALLIANCE OB GYN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-484-7100
Mailing Address - Street 1:323 N BONNIE BRAE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3727
Mailing Address - Country:US
Mailing Address - Phone:940-484-7100
Mailing Address - Fax:940-484-7101
Practice Address - Street 1:323 N BONNIE BRAE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3727
Practice Address - Country:US
Practice Address - Phone:940-484-7100
Practice Address - Fax:940-484-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182934301Medicaid
TX182934301Medicaid
TX=========OtherTAX IDENTIFICATION NUMBER