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General NPI Number Information
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NPI Number | 1205362407
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Entity Type | Organization
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Legal Business Name | ROBERT D. WILCOX, MD, PA
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Dates
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Enumeration Date | 05/08/2017
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Last Update Date | 05/24/2017
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Provider Practice Location Address
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Address Line | 5316 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-4821
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Country | US
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Telephone | 972-620-1700
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Fax | 972-248-2333
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Provider Business Mailing Address
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Address Line | 5316 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-4821
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Country | US
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Telephone | 972-620-1700
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Fax | 972-248-2333
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Authorized Official
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Title or Position | FACILITY CONSULTANT
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Name | SHAWNA BOUDREAUX
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Credential |
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Telephone | 469-422-0641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 007155
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 007155
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License Number State | TX
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