Provider Demographics
NPI:1245274331
Name:WILKERSON, ANNE E (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:E
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLORADO ST
Mailing Address - Street 2:APT 2207
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4103
Mailing Address - Country:US
Mailing Address - Phone:805-305-3863
Mailing Address - Fax:
Practice Address - Street 1:3010 WILLIAMS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2764
Practice Address - Country:US
Practice Address - Phone:512-368-4944
Practice Address - Fax:512-869-0964
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92649207ZP0101X
TXP1714207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A926490Medicaid
CAGR0058760Medicaid
CA00A926490Medicaid
TXTXB165586Medicare PIN
CAWA92649AMedicare PIN
CACN6729Medicare PIN
CAI48500Medicare UPIN