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General NPI Number Information
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NPI Number | 1114920444
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Entity Type | Individual
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Provider Name | JOHN RICHARDSON WILCOX JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 4777 US HIGHWAY 259
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City | LONGVIEW
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State | TX
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Zip | 75605-7668
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Country | US
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Telephone | 903-663-4800
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Fax | 903-663-0378
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Provider Business Mailing Address
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Address Line | PO BOX 5316
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City | LONGVIEW
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State | TX
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Zip | 75608-5316
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Country | US
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Telephone | 903-663-4800
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Fax | 903-663-0378
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | F0824
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | F0824
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License Number State | TX
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