Provider Demographics
NPI:1528233491
Name:WILKINSON, CHARLES KEITH (NMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5609 W TOMBSTONE TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-7332
Mailing Address - Country:US
Mailing Address - Phone:623-229-5345
Mailing Address - Fax:480-609-4233
Practice Address - Street 1:9097 E DESERT COVE DR
Practice Address - Street 2:100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6279
Practice Address - Country:US
Practice Address - Phone:480-609-4200
Practice Address - Fax:480-609-4233
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-977175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath