Provider Demographics
NPI:1861504516
Name:WILKERSON, RUTH C (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:C
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4850 SW 91 TERRACE
Mailing Address - Street 2:STE P 102
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6038
Mailing Address - Country:US
Mailing Address - Phone:352-376-2211
Mailing Address - Fax:352-376-2211
Practice Address - Street 1:4850 SW 91 TERRACE
Practice Address - Street 2:STE P 102
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6038
Practice Address - Country:US
Practice Address - Phone:352-376-2211
Practice Address - Fax:352-376-2211
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FL14843207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
01165Medicare UPIN