Provider Demographics
NPI:1164402251
Name:WILKES, TAYLOR D (MD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:D
Last Name:WILKES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9800 BAPTIST HEALTH 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 BAPTIST HEALTH DRIVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2012-10-19
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Provider Licenses
StateLicense IDTaxonomies
ARC5113207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104882001Medicaid
ARE05428Medicare UPIN
AR104882001Medicaid