1366425944 NPI number — DALERIE A. WILKERSON DPM

Table of content: YASIN OBEIDAT M.B.B.S. (NPI 1508488826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366425944 NPI number — DALERIE A. WILKERSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKERSON
Provider First Name:
DALERIE
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366425944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E OVERTON RD
Provider Second Line Business Practice Location Address:
BLUITT-FLOWERS HEALTH CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216-5946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-4200
Provider Business Practice Location Address Fax Number:
214-266-4218
Provider Enumeration Date:
11/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1527 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 143872311 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872309 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872312 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8W8850 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 143872302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872314 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872310 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 143872313 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".