Provider Demographics
NPI:1275590259
Name:WILKINSON, PHILIP L (MB,BS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MB,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8752
Mailing Address - Country:US
Mailing Address - Phone:707-527-7989
Mailing Address - Fax:
Practice Address - Street 1:HEALTHSOUTH SURGERY CENTER
Practice Address - Street 2:1111 SONOMA AVE
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-578-4100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26436207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology