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NPI Code Detail

MEDICARE: TRACY LEE WILKERSON D.O

MEDICARE: TRACY LEE WILKERSON D.O
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
1207V00000XObstetrics & Gynecology Physician4707OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P01083969OTHEROKRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15101016863OTHERMISTATE LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44707OTHEROKOK

General Provider Information

NPI Number : 1952517732
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY LEE WILKERSON D.O
Provider Business Mailing Address
First Line : 101 S PARK LN
Second Line :
City : ALTUS
State : OK
Zip : 73521-5731
Country : US
Telephone Number : 580-379-6140
Fax Number : 580-379-6149
Provider Business Practice Location Address
First Line : 101 S PARK LN
Second Line :
City : ALTUS
State : OK
Zip : 73521-5731
Country : US
Telephone Number : 580-379-6140
Fax Number : 580-379-6149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 12/28/2025

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