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General NPI Number Information
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NPI Number | 1083939821
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Entity Type | Individual
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Provider Name | ALTON JEROME WILKS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 03/30/2016
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Provider Practice Location Address
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Address Line | 212 W WINTERGREEN RD APT 2028
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City | DESOTO
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State | TX
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Zip | 75115-2360
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Country | US
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Telephone | 214-457-5528
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Fax |
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Provider Business Mailing Address
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Address Line | 212 W WINTERGREEN RD APT 2028
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City | DESOTO
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State | TX
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Zip | 75115-2360
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Country | US
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Telephone | 214-457-5528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 2164
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 2164
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2164
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License Number State | TX
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