Keith C Wilson, LSA
Specialist/Technologist, Other, Surgical Assistant in Fresno, TX. Individual provider (NPI-1).
NPI number1467604744
StatusActive
Last updated in NPPESOct 31, 2016
Details
- NPI
- 1467604744
- Entity type
- Individual (NPI-1)
- Name
- Keith C Wilson
- Credential
- LSA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Oct 16, 2008
- Last updated
- Oct 31, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | SA00410 | TX | Yes |
Practice location
2503 Robin Knoll CtFresno, TX 77545-8167
Phone 281-509-2017
Mailing address
2503 Robin Knoll CtFresno, TX 77545-8167
Phone 281-509-2017
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