Provider Demographics
NPI:1528374006
Name:WILKINS, MARCUS E (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:E
Last Name:WILKINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-412-7400
Mailing Address - Fax:480-412-5991
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-412-7400
Practice Address - Fax:480-412-5991
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131168Medicare PIN