Healthcare Provider Details

I. General information

NPI: 1477540276
Provider Name (Legal Business Name): LEE A WILCOX M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

PO BOX 5157
VANCOUVER WA
98668-5157
US

V. Phone/Fax

Practice location:
  • Phone: 360-667-3056
  • Fax: 360-666-0466
Mailing address:
  • Phone: 360-667-3056
  • Fax: 360-666-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00032952
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: