Provider Demographics
NPI:1285699397
Name:WILKERSON, JOHN P JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:WILKERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 431050
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33243-1060
Mailing Address - Country:US
Mailing Address - Phone:305-669-4426
Mailing Address - Fax:305-669-4183
Practice Address - Street 1:6705 RED ROAD
Practice Address - Street 2:SUITE 418
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3644
Practice Address - Country:US
Practice Address - Phone:305-669-4426
Practice Address - Fax:305-669-4183
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82518207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH83075Medicare UPIN
01080YMedicare ID - Type Unspecified