Provider Demographics
NPI:1740385533
Name:WILKS, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:WILKS
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 1:9100 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4417
Mailing Address - Country:US
Mailing Address - Phone:405-840-4456
Mailing Address - Fax:405-840-4295
Practice Address - Street 1:9100 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-4417
Practice Address - Country:US
Practice Address - Phone:405-840-4456
Practice Address - Fax:405-840-4295
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126150CMedicaid
OK100126150CMedicaid
OK400522460Medicare ID - Type Unspecified
OK202213694OtherTAX ID NUMBER