1538433115 NPI number — HUGH WILKINSON,MD PA

Table of content: MADISON HAZE OKMIN MS, RDN (NPI 1790515971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538433115 NPI number — HUGH WILKINSON,MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUGH WILKINSON,MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1538433115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10416 SAINT GERMAIN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33449-8058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-516-0512
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 S SEACREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
BOYNTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33435-7944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-740-7970
Provider Business Practice Location Address Fax Number:
561-740-7980
Provider Enumeration Date:
02/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILKINSON
Authorized Official First Name:
HUGH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-740-7970

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  ME94184 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FL 273894500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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