Healthcare Provider Details

I. General information

NPI: 1215965579
Provider Name (Legal Business Name): ROBERT MARC WYCOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/14/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W. EXCHANGE PKWY EMERGENCY DEPARTMENT
ALLEN TX
75013
US

IV. Provider business mailing address

2130 ARCHES PARK DR
ALLEN TX
75013-5642
US

V. Phone/Fax

Practice location:
  • Phone: 972-678-4545
  • Fax:
Mailing address:
  • Phone: 859-948-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34123
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP6556
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: