Provider Demographics
NPI:1740314657
Name:WILKERSON, KEITH WADE (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:WADE
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3150 MATLOCK RD STE 405
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2924
Mailing Address - Country:US
Mailing Address - Phone:817-472-6555
Mailing Address - Fax:817-472-6562
Practice Address - Street 1:3150 MATLOCK RD
Practice Address - Street 2:SUITE 405
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2992
Practice Address - Country:US
Practice Address - Phone:817-472-6555
Practice Address - Fax:817-472-6562
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2022-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH0937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB27582Medicare UPIN