Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G3911 | TX |
NPI | 1013926427 |
---|---|
Provider Name | Lloyd Michael Wilkinson |
First Address | Palestine, TX 75801-4786 |
Second Address | Palestine, TX 75801-4786 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 27/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110105889 | RAILROAD MEDICARE (01) | TX |
131685303 | (05) | TX |
C23493 | (02) | TX |