| Doctor Name: | ALTON JEROME WILKS |
| NPI Number: | 1083939821 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.M. |
| License Number: | 2164 |
| Business Practice Address: | 212 W Wintergreen Rd Apt 2028 Desoto, TX - 751152360 |
| Business Phone Number: | 2144575528 |
| Business Fax Number: | |
| Mailing Address: | 212 W Wintergreen Rd Apt 2028, DESOTO |
| State: | TX |
| Postal Code: | 751152360 |
| Phone Number: | 2144575528 |
| Fax Number: | |
| NPI Enumeration Date: | 04/05/2010 |
| NPI Last Update Date: | 03/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 2164 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |