Provider Demographics
NPI:1023269172
Name:WILSON, JAMES MICHAEL (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-525-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7150810-1205207P00000X
TXN8874207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-028OtherTRICARE
TX8CS712OtherBCBS
TX8EY087OtherBCBS
TXP01439634OtherRAIL ROAD MEDICARE
TX1G4019OtherMEDICARE
TX75-2616977-002OtherTRICARE
TX750818167044OtherTRICARE
TX280231602Medicaid
TX750818167022OtherTRICARE
TX751976930005OtherTRICARE -JACKSONVILLE
TX8X8164OtherBCBS
TX75-0818167-048OtherTRICARE
TX280231601Medicaid
TX75-0818167-015OtherTRICARE
TX75-2616977-001OtherTRICARE
TX8CT074OtherBCBS
TX75-2616977-002OtherTRICARE
TX280231602Medicaid
TX750818167044OtherTRICARE
TXTXB131333Medicare Oscar/Certification
TX391230YMAFMedicare PIN