Provider Demographics
NPI:1043249550
Name:WILKINS, BENJAMAN TRAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMAN
Middle Name:TRAVIS
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6848
Mailing Address - Country:US
Mailing Address - Phone:501-279-0502
Mailing Address - Fax:501-279-0506
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6848
Practice Address - Country:US
Practice Address - Phone:501-279-0502
Practice Address - Fax:501-279-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150628001Medicaid
ARH93540Medicare UPIN