Provider Demographics
NPI:1477541563
Name:WILSON, ALAN KIRK (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:KIRK
Last Name:WILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:870-460-3515
Mailing Address - Fax:870-460-3529
Practice Address - Street 1:778 SCOGIN DR STE 140
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5729
Practice Address - Country:US
Practice Address - Phone:870-460-3515
Practice Address - Fax:870-460-3529
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K637OtherBCBS
AR132894001Medicaid
AR180320000OtherQUALCHOICE
AR020036876OtherMEDICARE RAILROAD
AR020036876OtherMEDICARE RAILROAD