Provider Demographics
NPI:1730234501
Name:WILKINSON, JOHN DAVID (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 S BRYANT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6330
Mailing Address - Country:US
Mailing Address - Phone:405-622-3063
Mailing Address - Fax:855-680-8890
Practice Address - Street 1:105 S BRYANT AVE STE 101
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6330
Practice Address - Country:US
Practice Address - Phone:405-622-3063
Practice Address - Fax:855-680-8890
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK14808207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA33487OtherSTATE MEDICAL LICENSE
GA33487OtherSTATE MEDICAL LICENSE
GA33487OtherSTATE MEDICAL LICENSE
GABW0281410OtherDEA