MEDICARE: AARON PAUL WILCOX D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4823	OK

General Provider Information

NPI Number	:	1518195221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON PAUL WILCOX D.O.

Provider Business Mailing Address
First Line	:	415 FAIRVIEW AVE STE 201
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1932
Country	:	US
Telephone Number	:	580-762-9355
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 FAIRVIEW AVE STE 201
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1932
Country	:	US
Telephone Number	:	580-762-9355
Fax Number	:	580-762-3420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	11/04/2021

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