Provider Demographics
NPI:1922080860
Name:WILKETT, DAVID MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MATTHEW
Last Name:WILKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S JACKSON AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9049
Mailing Address - Country:US
Mailing Address - Phone:918-582-7711
Mailing Address - Fax:918-583-5831
Practice Address - Street 1:802 S JACKSON AVE STE 225
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9049
Practice Address - Country:US
Practice Address - Phone:918-582-7711
Practice Address - Fax:918-583-5831
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3798207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA101033OtherMEDICARE
OK200121230BMedicaid