Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | E9019 | TX |
NPI | 1003874033 |
---|---|
Provider Name | Dr. Joe B Wilkinson |
First Address | San Angelo, TX 76904-6884 |
Second Address | San Angelo, TX 76904-6884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 05/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102668401 | (05) | TX |
821804 | BLUE CROSS/BLUE SHIELD TX (01) | TX |
C23496 | (02) |