Healthcare Provider Details

I. General information

NPI: 1730177486
Provider Name (Legal Business Name): DENNIS DREWE WILCOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 JANES RD
ARCATA CA
95521-4742
US

IV. Provider business mailing address

3412 LETZ AVE
MCKINLEYVILLE CA
95519-9101
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2279
  • Fax: 707-825-4988
Mailing address:
  • Phone: 707-822-2279
  • Fax: 707-825-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA44471
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: