Provider Demographics
NPI:1366425944
Name:WILKERSON, DALERIE A (DPM)
Entity type:Individual
Prefix:
First Name:DALERIE
Middle Name:A
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E OVERTON RD
Practice Address - Street 2:BLUITT-FLOWERS HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-5946
Practice Address - Country:US
Practice Address - Phone:214-266-4200
Practice Address - Fax:214-266-4218
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1527213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143872311Medicaid
TX143872306Medicaid
TX143872309Medicaid
TX143872312Medicaid
TX8W8850OtherBLUE CROSS BLUE SHIELD
TX143872302Medicaid
TX143872305Medicaid
TX143872314Medicaid
TX143872307Medicaid
TX143872304Medicaid
TX143872308Medicaid
TX143872310Medicaid
TX143872313Medicaid
TX143872312Medicaid
TX8063NPMedicare PIN