Individual
DR. GARY ALLAN WIKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
29 TAYLOR AVE, SUITE 210, CROSSVILLE, TN 38555-4527
(931) 707-5313
(931) 484-4856
Mailing address
29 TAYLOR AVE, SUITE 210, CROSSVILLE, TN 38555-4527
(931) 707-5313
(931) 484-4856
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD0000034776
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3735040
—
TN
01
—
POO906801
MCR RR
TN
Enumeration date
02/20/2006
Last updated
07/08/2011
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