Provider Demographics
NPI:1043429186
Name:WILKINS, DARYL JAMES (DO)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:JAMES
Last Name:WILKINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:CA
Mailing Address - Zip Code:95236-1424
Mailing Address - Country:US
Mailing Address - Phone:209-887-3891
Mailing Address - Fax:209-887-2517
Practice Address - Street 1:4950 BONHAM DR
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:CA
Practice Address - Zip Code:95236-9491
Practice Address - Country:US
Practice Address - Phone:209-887-3891
Practice Address - Fax:209-887-2517
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 6047207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60470Medicaid
CA00AX60470Medicaid