Individual
JOHN DAVID WILKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 MEDICAL PLZ, SUITE 100, LAKE ST LOUIS, MO 63367-1490
(636) 639-8600
(636) 639-8676
Mailing address
500 MEDICAL DRIVE, WENTZVILLE, MO 63385
(636) 327-1202
(636) 327-1222
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
R7J99
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208002113
—
MO
01
—
273988
HEALTHLINK
—
01
—
3609028
UHC
—
01
—
4676254
AETNA
—
01
—
57015
GHP
—
01
—
6198
BCBS
MI
01
—
6198
BC
—
01
—
900002001
RR MEDICARE
—
Enumeration date
04/08/2006
Last updated
09/10/2012
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