Provider Demographics
NPI:1558455469
Name:WILKINSON, TOLBERT S (MD)
Entity Type:Individual
Prefix:DR
First Name:TOLBERT
Middle Name:S
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 1:109 GALLERY CIR
Mailing Address - Street 2:SUITE 127
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3327
Mailing Address - Country:US
Mailing Address - Phone:210-495-8825
Mailing Address - Fax:210-495-7145
Practice Address - Street 1:109 GALLERY CIR
Practice Address - Street 2:SUITE 127
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3327
Practice Address - Country:US
Practice Address - Phone:210-495-8825
Practice Address - Fax:210-495-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8842174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1592545Medicaid
TXB27585Medicare UPIN
TX8A7320Medicare ID - Type Unspecified