Provider Demographics
NPI:1013926427
Name:WILKINSON, LLOYD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:MICHAEL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2217 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4786
Mailing Address - Country:US
Mailing Address - Phone:903-729-3993
Mailing Address - Fax:903-729-6558
Practice Address - Street 1:2217 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4786
Practice Address - Country:US
Practice Address - Phone:903-729-3993
Practice Address - Fax:903-729-6558
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3911207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131685303Medicaid
TX110105889OtherRAILROAD MEDICARE
TX110105889OtherRAILROAD MEDICARE
TX131685303Medicaid