Provider Demographics
NPI:1497912521
Name:WILKS, SARAH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
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 1:1702 N BURNSIDE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2141
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-644-0341
Practice Address - Street 1:1702 N BURNSIDE AVE STE C
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2141
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-644-0341
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204850208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11819Medicaid