Dr. Charles R Wilson, D.O.
Family Medicine in Sour Lake, TX. Individual provider (NPI-1).
NPI number1790799807
StatusActive
Last updated in NPPESMay 1, 2013
Details
- NPI
- 1790799807
- Entity type
- Individual (NPI-1)
- Name
- Dr. Charles R Wilson
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 27, 2006
- Last updated
- May 1, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | H8516 | TX | Yes |
Practice location
327 Morris Rd WSour Lake, TX 77659-9774
Phone 409-753-2577
Mailing address
327 Morris Rd WSour Lake, TX 77659-9774
Phone 409-753-2577
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Other Family Medicine Physician providers in Sour Lake, TX
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