Provider Demographics
NPI:1417159807
Name:WILKINSON SNOWDEN OTOLARYNGOLOGY CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:WILKINSON SNOWDEN OTOLARYNGOLOGY CONSULTANTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:904-268-5366
Mailing Address - Street 1:14546 SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-268-5366
Mailing Address - Fax:904-268-5457
Practice Address - Street 1:14546 SAINT AUGUSTINE RD
Practice Address - Street 2:STE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-268-5366
Practice Address - Fax:904-268-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56965174400000X
FLME81538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45761OtherBCBS GROUP PROVIDER #
FLCJ2313OtherRAILROAD GROUP #
FLG49115Medicare UPIN
FL09996YMedicare ID - Type UnspecifiedDR. WILKINSON'S MEDICARE#
FLCJ2313OtherRAILROAD GROUP #
FL45761OtherBCBS GROUP PROVIDER #
FLK2582Medicare ID - Type UnspecifiedGROUP # FOR MEDICARE