Healthcare Provider Details

I. General information

NPI: 1871913905
Provider Name (Legal Business Name): JAMES EDWARD PILKINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S 11TH ST
LAKE WALES FL
33853-4243
US

IV. Provider business mailing address

407 S 11TH ST
LAKE WALES FL
33853-4243
US

V. Phone/Fax

Practice location:
  • Phone: 863-679-2707
  • Fax: 863-676-3621
Mailing address:
  • Phone: 863-679-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME139761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: