Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME0056965 | FL |
N | 207YS0123X | Facial Plastic Surgeon | ME0056965 | FL |
NPI | 1609878313 |
---|---|
Provider Name | Dr. Albert H Wilkinson III |
First Address | Jacksonville, FL 32258-5468 |
Second Address | Jacksonville, FL 32258-5468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 13/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09996 | BCBS (01) | FL |
A99211 | (02) |