Healthcare Provider Details

I. General information

NPI: 1013354687
Provider Name (Legal Business Name): YLICIA RICHARDS WAKEFIELD, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 THOMASVILLE
GARLAND TX
75044-3477
US

IV. Provider business mailing address

1224 THOMASVILLE
GARLAND TX
75044-3477
US

V. Phone/Fax

Practice location:
  • Phone: 972-741-8417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2278
License Number StateTX

VIII. Authorized Official

Name: DR. YLICIA RICHARDS WAKEFIELD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-741-8417