Active NPI
Bruce E Wilks, MD
- Family Medicine Physician
- Carrboro, NC
National Provider Identifier
1457305310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 29687
- Practice address
- 610 Jones Ferry Rd
Ste 102
Carrboro, NC 27510-6113 - Phone
- (919) 929-1747
- Fax
- (919) 933-5168
- NPI assigned
- May 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 29687 | NC | Primary |
Addresses
Primary practice location
610 Jones Ferry Rd
Ste 102
Carrboro, NC 27510-6113
Mailing address
610 Jones Ferry Rd
Ste 102
Carrboro, NC 27510-6113
Phone (919) 929-1747
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87616 | Other | NC | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29687 | NC | MD | Ambulatory Care Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Raleigh Durham Medical Group PA | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Cary, NC
- NPI 1295784874
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303344000000",
"number": "1457305310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 JONES FERRY RD",
"address_2": "STE 102",
"city": "CARRBORO",
"state": "NC",
"postal_code": "275106113",
"telephone_number": "919-929-1747",
"fax_number": "919-933-5168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 JONES FERRY RD",
"address_2": "STE 102",
"city": "CARRBORO",
"state": "NC",
"postal_code": "275106113",
"telephone_number": "919-929-1747",
"fax_number": "919-933-5168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKS",
"first_name": "BRUCE",
"middle_name": "E",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-22",
"last_updated": "2011-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NC",
"license": "29687",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "87616",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Carrboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.