Provider Demographics
NPI:1932115961
Name:WILKERSON, DANNY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:LEE
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST
Mailing Address - Street 2:SLOT 515
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-6667
Mailing Address - Fax:501-686-8139
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:SLOT 515
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-6667
Practice Address - Fax:501-686-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6483207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR55682OtherBCBS
ARC6483OtherTRICARE
AR16508000000OtherQUALCHOICE
ARP00020612OtherRAILROAD MEDICARE
ARP00020612OtherRAILROAD MEDICARE
AR55682Medicare ID - Type Unspecified