Healthcare Provider Details

I. General information

NPI: 1558353003
Provider Name (Legal Business Name): JAMES A WILKERSON IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W OLIVE AVE SUITE 310
MERCED CA
95348-2419
US

IV. Provider business mailing address

625 W OLIVE AVE SUITE 310
MERCED CA
95348-2419
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-4551
  • Fax: 209-723-0141
Mailing address:
  • Phone: 209-723-4551
  • Fax: 209-723-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG84167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: