Provider Demographics
NPI:1609878313
Name:WILKINSON, ALBERT H III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:H
Last Name:WILKINSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14546 SAINT AUGUSTINE RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5468
Mailing Address - Country:US
Mailing Address - Phone:904-268-5366
Mailing Address - Fax:904-268-5457
Practice Address - Street 1:14546 SAINT AUGUSTINE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5468
Practice Address - Country:US
Practice Address - Phone:904-268-5366
Practice Address - Fax:904-268-5457
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056965207Y00000X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09996OtherBCBS
FL09996YMedicare ID - Type Unspecified
A99211Medicare UPIN
FL09996XMedicare PIN