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General NPI Number Information
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NPI Number | 1942336052
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Entity Type | Individual
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Provider Name | PHILIP ANDERS WIXOM MD
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 6037 PRICE AVE
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City | MCCLELLAN
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State | CA
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Zip | 95652-2400
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Country | US
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Telephone | 279-345-3580
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Fax | 916-643-7708
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Provider Business Mailing Address
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Address Line | 1779 KEESLER CIR
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City | SUISUN CITY
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State | CA
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Zip | 94585-6326
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101240912
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License Number State | VA
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