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General NPI Number Information
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NPI Number | 1124580030
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Entity Type | Individual
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Provider Name | FLOYD WILKS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1851 MESQUITE AVE STE 210
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5681
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Country | US
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Telephone | 928-854-7540
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Fax | 928-854-2405
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Provider Business Mailing Address
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Address Line | 657 ISLAND DR
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-6943
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Country | US
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Telephone | 407-538-9250
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 76349
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License Number State | AZ
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