Provider Demographics
NPI:1962076901
Name:WILSON, ROSE MARY (DPM)
Entity type:Individual
Prefix:DR
First Name:ROSE MARY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5804 COIT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5955
Mailing Address - Country:US
Mailing Address - Phone:972-424-3505
Mailing Address - Fax:972-424-0903
Practice Address - Street 1:5804 COIT RD STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5955
Practice Address - Country:US
Practice Address - Phone:972-424-3505
Practice Address - Fax:972-424-0903
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX692119207XX0004X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery