Provider Demographics
NPI:1902821713
Name:WILKS, GARY BLAFER (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BLAFER
Last Name:WILKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7758 WISCONSIN AVE
Mailing Address - Street 2:211
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3530
Mailing Address - Country:US
Mailing Address - Phone:301-530-3237
Mailing Address - Fax:301-907-4590
Practice Address - Street 1:7758 WISCONSIN AVE
Practice Address - Street 2:211
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3530
Practice Address - Country:US
Practice Address - Phone:301-530-3237
Practice Address - Fax:301-907-4590
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD55258207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415096100Medicaid
MDF97226Medicare UPIN
MD080000931Medicare ID - Type Unspecified
MD415096100Medicaid