Individual
G JASON WILKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1813 W HARVARD AVE STE 201, ROSEBURG, OR 97471-2754
(541) 673-0742
(541) 673-7553
Mailing address
1813 W HARVARD AVE STE 201, ROSEBURG, OR 97471-2754
(541) 673-0742
(541) 673-7553
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00318
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067946000
REGENCE
OR
01
—
430895102
REGENCE BC HMO
OR
01
—
480028890
RR MEDICARE
—
05
—
500720262
—
OR
01
—
7600580001
PTAN DME
OR
01
—
D201111
PACIFIC SOURCE
OR
01
—
DX4938
RR MDC GROUP PTAN
OR
01
—
R192914
PTAN MEDICARE ORGANIZATION
OR
Enumeration date
12/06/2006
Last updated
11/12/2025
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