Individual provider · Type 1 NPI
Larry Don Wilson, PA-C
Medical Physician Assistant · Bacliff, TX
NPI number
1306848981
Active
Practice location
1136 Grand Ave
Bacliff, TX 77518-2760
Fax (281) 339-5098
Mailing address
2826 Forest Hills Dr
League City, TX 77573-5750
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Medical Physician Assistant Primary | 363AM0700X | PA00742 (TX) |
Medical Physician Assistant: Definition to come...
3 other providers at this address
About NPI 1306848981
Larry Don Wilson, PA-C's National Provider Identifier is 1306848981, issued on Aug 12, 2005. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Bacliff, TX. The record was last updated on Dec 21, 2010.