Provider Demographics
NPI:1528096815
Name:WILSON, RONALD THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:THOMAS
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2548 LILLIAN MILLER PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7212
Mailing Address - Country:US
Mailing Address - Phone:940-383-5963
Mailing Address - Fax:940-382-3330
Practice Address - Street 1:2548 LILLIAN MILLER PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-7212
Practice Address - Country:US
Practice Address - Phone:940-383-5963
Practice Address - Fax:940-382-3330
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF61732083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC23655Medicare UPIN