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General NPI Number Information
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NPI Number | 1457305310
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Entity Type | Individual
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Provider Name | BRUCE E WILKS MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 610 JONES FERRY RD STE 102
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City | CARRBORO
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State | NC
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Zip | 27510-6113
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Country | US
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Telephone | 919-929-1747
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Fax | 919-933-5168
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Provider Business Mailing Address
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Address Line | 610 JONES FERRY RD STE 102
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City | CARRBORO
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State | NC
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Zip | 27510-6113
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Country | US
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Telephone | 919-929-1747
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Fax | 919-933-5168
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29687
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License Number State | NC
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