Provider Demographics
NPI:1083941587
Name:T DAVID I WILKES MD PA
Entity Type:Organization
Organization Name:T DAVID I WILKES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:T DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:WILKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-221-0123
Mailing Address - Street 1:9800 LILE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6229
Mailing Address - Country:US
Mailing Address - Phone:501-221-0123
Mailing Address - Fax:501-227-8859
Practice Address - Street 1:9800 LILE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6229
Practice Address - Country:US
Practice Address - Phone:501-221-0123
Practice Address - Fax:501-227-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty