MEDICARE: DEBORAH WILCOX DOM

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	171100000X	Acupuncturist	AP3626	FL

General Provider Information

NPI Number	:	1346613015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH WILCOX DOM

Provider Business Mailing Address
First Line	:	3150 N ATLANTIC AVE # 770-14
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-5831
Country	:	US
Telephone Number	:	321-394-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N TROPICAL TRL
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4737
Country	:	US
Telephone Number	:	321-394-8038
Fax Number	:

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

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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