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General NPI Number Information
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NPI Number | 1659443935
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Entity Type | Individual
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Provider Name | GLENN JOSEPH WILCOX DPM
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3300 DOUGLAS AVE
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 214-526-3336
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Fax | 214-526-3337
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Provider Business Mailing Address
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Address Line | 3300 DOUGLAS AVE
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City | DALLAS
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State | TX
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Zip | 75219
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Country | US
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Telephone | 214-526-3336
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Fax | 214-526-3337
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1394
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 963253170501
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License Number State | UT
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