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General NPI Number Information
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NPI Number | 1245541739
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Entity Type | Organization
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Legal Business Name | METROPLEX VASCULAR SPECIALISTS, PLLC
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 1600 W COLLEGE ST SUITE 555
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City | GRAPEVINE
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State | TX
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Zip | 76051-3580
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Country | US
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Telephone | 817-310-0020
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Fax | 817-796-1445
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Provider Business Mailing Address
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Address Line | 1600 W COLLEGE ST SUITE 555
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City | GRAPEVINE
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State | TX
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Zip | 76051-3580
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Country | US
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Telephone | 817-310-0020
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Fax | 817-796-1445
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD JEROME WILKERSON
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Credential | MD
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Telephone | 817-310-0020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | K9455
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License Number State | TX
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