Provider Demographics
NPI:1003813320
Name:WILKERSON, CLIFTON E (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:E
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 LEWIS LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9378
Mailing Address - Country:US
Mailing Address - Phone:903-784-0800
Mailing Address - Fax:903-784-0866
Practice Address - Street 1:2850 LEWIS LN
Practice Address - Street 2:SUITE 101
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9378
Practice Address - Country:US
Practice Address - Phone:903-784-0800
Practice Address - Fax:903-784-0866
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2019-03-21
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TXK2825207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B3100Medicare PIN
TXH17207Medicare UPIN