Provider Demographics
NPI:1811047798
Name:WIKOFF UROLOGY, P.A.
Entity type:Organization
Organization Name:WIKOFF UROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-784-4044
Mailing Address - Street 1:2915 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9360
Mailing Address - Country:US
Mailing Address - Phone:903-784-4044
Mailing Address - Fax:903-784-4201
Practice Address - Street 1:2915 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9360
Practice Address - Country:US
Practice Address - Phone:903-784-4044
Practice Address - Fax:903-784-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDA2698OtherRAILROAD MEDICARE
TX0012HZOtherBCBS
OK200003550AOtherOKLAHOMA MEDICAID
TX153197201Medicaid
TX007847195OtherAETNA
TX007847195OtherAETNA
TX153197201Medicaid