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Larry Don Wilson, PA-C
Medical Physician Assistant in Bacliff, Texas
NPI 1306848981

Larry Don Wilson is a Medical Physician Assistant based in League City, TX and is specialized in Medical. Larry Don Wilson practices in Bacliff, TX and has the professional credentials of PA-C. The NPI Number for Larry Don Wilson is 1306848981 and holds a License No. PA00742 (Texas).

The current practice location address for Larry Don Wilson is 1136 Grand Ave, Bacliff, TX and can be reached out via phone at 281-339-5018 and via fax at 281-339-5098.

Location: 1136 Grand Ave, Bacliff, TX, 77573-5750
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1306848981
Provider Name
Larry Don Wilson
Credential
PA-C
Provider Entity Type
Individual
Gender
Male
Address
1136 Grand Ave, Bacliff, TX, 77573-5750
Phone Number
281-339-5018
Fax Number
281-339-5098
Provider Enumeration Date
08/12/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PA00742 01 TX STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
1136 Grand Ave
City
Bacliff
State
Texas
Zip
77518-2760
Phone Number
281-339-5018
Fax Number
281-339-5098
person
Provider Business Mailing Address Details
Address
1136 Grand Ave
City
Bacliff
State
Texas
Zip
77518-2760
Phone Number
281-339-5018
Fax Number
281-339-5098
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
PA00742 (Texas)
Definition
Definition to come...
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