Provider Demographics
NPI:1164490694
Name:WILKINSON, THORNTON THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THORNTON
Middle Name:THOMAS
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:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0031
Mailing Address - Country:US
Mailing Address - Phone:509-529-1284
Mailing Address - Fax:
Practice Address - Street 1:800 SWIFT BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3549
Practice Address - Country:US
Practice Address - Phone:509-946-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041443207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116573Medicaid
WAA02325Medicare UPIN
WA1116573Medicaid