Provider Demographics
NPI:1174721260
Name:DAVID B. WILKINSON MD PC
Entity type:Organization
Organization Name:DAVID B. WILKINSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-2542
Mailing Address - Street 1:9427 SW BARNES RD
Mailing Address - Street 2:SUITE 595
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-292-2542
Mailing Address - Fax:503-292-4309
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 595
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-292-2542
Practice Address - Fax:503-292-4309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24784174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR120883Medicare PIN
ORI17026Medicare UPIN