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NPI Code Detail

MEDICARE: DR. WALLACE G WILKERSON MD

MEDICARE: DR. WALLACE G WILKERSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianME0039668FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508852542
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WALLACE G WILKERSON MD
Provider Business Mailing Address
First Line : 5840 W CYPRESS ST
Second Line : B
City : TAMPA
State : FL
Zip : 33607-7004
Country : US
Telephone Number : 813-286-0033
Fax Number : 813-282-1806
Provider Business Practice Location Address
First Line : 5840 W CYPRESS ST
Second Line : B
City : TAMPA
State : FL
Zip : 33607-7004
Country : US
Telephone Number : 813-286-0033
Fax Number : 813-282-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 07/12/2013

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Directions to “ DR. WALLACE G WILKERSON MD” Practice Location

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