Provider Demographics
NPI:1255566592
Name:WIKOFF, RICHARD PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:WIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 961205
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-1205
Mailing Address - Country:US
Mailing Address - Phone:817-740-8400
Mailing Address - Fax:817-852-8780
Practice Address - Street 1:1741 EAST BARDIN ROAD, SUITE 291
Practice Address - Street 2:JPS OUT-PATIENT CLINIC
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-4825
Practice Address - Country:US
Practice Address - Phone:817-702-8700
Practice Address - Fax:817-702-4243
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4807208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206141802Medicaid