Provider Demographics
NPI:1275678872
Name:WILKS, REBECCA LEE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:WILKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 W BELL RD
Mailing Address - Street 2:#2
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-694-6575
Mailing Address - Fax:
Practice Address - Street 1:6206 W BELL RD
Practice Address - Street 2:#2
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-694-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20742171100000X, 207V00000X
AZ0160175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No171100000XOther Service ProvidersAcupuncturist
No175L00000XOther Service ProvidersHomeopath