Healthcare Provider Details

I. General information

NPI: 1114942257
Provider Name (Legal Business Name): DAVID LEE WILKEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BLDG D-102
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

2300 E 30TH ST BLDG D-102
FARMINGTON NM
87401-8990
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4429
  • Fax: 505-327-4420
Mailing address:
  • Phone: 505-327-4429
  • Fax: 505-327-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMD-2005-0736
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: