Provider Demographics
NPI:1902070188
Name:THE NEIGHBORHOOD DOCTOR
Entity Type:Organization
Organization Name:THE NEIGHBORHOOD DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-468-9999
Mailing Address - Street 1:5201 S COOPER ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-5964
Mailing Address - Country:US
Mailing Address - Phone:817-468-9999
Mailing Address - Fax:817-468-9733
Practice Address - Street 1:5201 S COOPER ST STE 111
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-5964
Practice Address - Country:US
Practice Address - Phone:817-468-9999
Practice Address - Fax:817-468-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3431208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty