Basic Information
| Provider Information | |||||||||
| NPI: | 1336151505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILKINS | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | VERNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 CASTLEGAR CT | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PLEASANT HILL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503277063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152651020 | ||||||||
| FaxNumber: | 5152651511 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 DIXON ST | ||||||||
| Address2: | SUITE E | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503162174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152651020 | ||||||||
| FaxNumber: | 5152651511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 18802 | IA | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.