Provider Demographics
NPI:1386732857
Name:WILKINS, DAVID L (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12260 PALM DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3908
Mailing Address - Country:US
Mailing Address - Phone:760-329-1393
Mailing Address - Fax:760-251-5645
Practice Address - Street 1:12260 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3908
Practice Address - Country:US
Practice Address - Phone:760-329-1393
Practice Address - Fax:760-251-5645
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG20682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G206821OtherMEDICARE PTAN -FAMILY PRACTICE
CAG20682Medicaid
CAG20682Medicaid