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General NPI Number Information
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NPI Number | 1235541400
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Entity Type | Organization
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Legal Business Name | C H WILKINSON PHYSICIAN NETWORK
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 2604 SAINT MICHAEL DR STE 410
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City | TEXARKANA
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State | TX
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Zip | 75503-2378
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Country | US
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Telephone | 903-614-5430
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Fax |
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Provider Business Mailing Address
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Address Line | 2604 SAINT MICHAEL DR STE 410
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City | TEXARKANA
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State | TX
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Zip | 75503-2378
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Country | US
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Telephone | 903-614-5430
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. PETER PLANTES
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Credential |
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Telephone | 469-282-2613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G0817
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License Number State | TX
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