Provider Demographics
NPI:1245541739
Name:METROPLEX VASCULAR SPECIALISTS, PLLC
Entity type:Organization
Organization Name:METROPLEX VASCULAR SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-310-0020
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:SUITE 555
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-310-0020
Mailing Address - Fax:817-796-1445
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 555
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-310-0020
Practice Address - Fax:817-796-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK94552086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty