MEDICARE: DR. DAN C WILCOX M.D.

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	01046852A	IN
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD60187002	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00885647	OTHER	WA	MEDICARE RAILROAD

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	:	1912900994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN C WILCOX M.D.

Provider Business Mailing Address
First Line	:	124 E ROWAN AVE
Second Line	:	STE 202
City	:	SPOKANE
State	:	WA
Zip	:	99207-1214
Country	:	US
Telephone Number	:	509-487-8000
Fax Number	:	509-487-6333

Provider Business Practice Location Address
First Line	:	124 E ROWAN AVE STE 202
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99207-1214
Country	:	US
Telephone Number	:	509-487-8000
Fax Number	:	509-487-6333

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	05/15/2020

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Directions to “ DR. DAN C WILCOX M.D.” Practice Location

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