Provider Demographics
NPI:1033118047
Name:WILKINSON, GEORGE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:L
Last Name:WILKINSON
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 1:702 MARSHALL ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1829
Mailing Address - Country:US
Mailing Address - Phone:650-367-0472
Mailing Address - Fax:650-367-0709
Practice Address - Street 1:702 MARSHALL ST
Practice Address - Street 2:SUITE 410
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1829
Practice Address - Country:US
Practice Address - Phone:650-367-0472
Practice Address - Fax:650-367-0709
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG212942084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G212940Medicare ID - Type UnspecifiedMEDICARE