MEDICARE: DR. PATRICK B WILCOX DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	15114	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003897257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK B WILCOX DDS

Provider Business Mailing Address
First Line	:	2501 CORNERSTONE BLVD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-8463
Country	:	US
Telephone Number	:	956-686-8611
Fax Number	:	956-686-2668

Provider Business Practice Location Address
First Line	:	2501 CORNERSTONE BLVD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-8463
Country	:	US
Telephone Number	:	956-686-8611
Fax Number	:	956-686-2668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	04/29/2014

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