Provider Demographics
NPI:1528056553
Name:WILSON, PAMELA DOYLENE (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:DOYLENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5535 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE F-104
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8021
Mailing Address - Country:US
Mailing Address - Phone:713-429-5919
Mailing Address - Fax:888-572-8004
Practice Address - Street 1:6100 RICHMOND AVE STE 125
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6240
Practice Address - Country:US
Practice Address - Phone:713-429-5919
Practice Address - Fax:888-572-8004
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8842174400000X, 208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AH490OtherBLUE CROSS BLUE SHIELD TEXAS
TXTXB140494Medicare PIN
TXG22063Medicare UPIN
TXTXB102925Medicare PIN