Individual
THOMAS ROBERT WIKSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6817 SOUTHPOINT PKWY, SUITE 2503, JACKSONVILLE, FL 32216-6282
(904) 396-0425
(904) 396-0448
Mailing address
6817 SOUTHPOINT PKWY, SUITE 2503, JACKSONVILLE, FL 32216-6282
(904) 396-0425
(904) 396-0448
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME0052161
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1952346553
NPI
FL
Enumeration date
06/18/2006
Last updated
12/22/2016
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