Provider Demographics
NPI:1477662260
Name:WILKINSON, EDUARDO M (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:M
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 1:1291 W CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2946
Mailing Address - Country:US
Mailing Address - Phone:469-600-2727
Mailing Address - Fax:
Practice Address - Street 1:1291 W CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2946
Practice Address - Country:US
Practice Address - Phone:972-301-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3937207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138724309Medicaid
752615263OtherTAX IDENTIFICATION NUMBER
TX138724309Medicaid
F57882Medicare UPIN