MEDICARE: MR. DAVID R. WILKERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	446	SC

General Provider Information

NPI Number	:	1194912014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID R. WILKERSON

Provider Business Mailing Address
First Line	:	1101 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-375-0669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N FANT ST
Second Line	:
City	:	ANDERSON
State	:	SC
Zip	:	29621-4819
Country	:	US
Telephone Number	:	864-375-0669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	09/25/2007

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