Provider Demographics
NPI:1174794119
Name:WILSON, RILEY
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 ROARKS PSGE
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6232
Mailing Address - Country:US
Mailing Address - Phone:713-884-5545
Mailing Address - Fax:
Practice Address - Street 1:23552 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-3468
Practice Address - Country:US
Practice Address - Phone:713-974-3131
Practice Address - Fax:713-974-3162
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8001803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport