Healthcare Provider Details

I. General information

NPI: 1427039056
Provider Name (Legal Business Name): PATRICIA A WILCOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6614 SANGER AVE
WACO TX
76710-4253
US

IV. Provider business mailing address

PO BOX 18962
BELFAST ME
04915-4084
US

V. Phone/Fax

Practice location:
  • Phone: 254-537-6100
  • Fax: 254-537-6101
Mailing address:
  • Phone: 800-566-5050
  • Fax: 254-537-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: