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General NPI Number Information
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NPI Number | 1215965579
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Entity Type | Individual
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Provider Name | ROBERT MARC WYCOFF MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1310 W. EXCHANGE PKWY EMERGENCY DEPARTMENT
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City | ALLEN
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State | TX
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Zip | 75013
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Country | US
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Telephone | 972-678-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 ARCHES PARK DR
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City | ALLEN
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State | TX
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Zip | 75013-5642
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Country | US
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Telephone | 859-948-8229
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 34123
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | P6556
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License Number State | TX
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