Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | K2825 | TX |
NPI | 1003813320 |
---|---|
Provider Name | Clifton E Wilkerson |
First Address | Paris, TX 75460-9378 |
Second Address | Paris, TX 75460-9378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 21/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H17207 | (02) | TX |