Provider Demographics
NPI:1033192901
Name:WILCOX, MOSES EDWARD SR (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:EDWARD
Last Name:WILCOX
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6224
Mailing Address - Country:US
Mailing Address - Phone:409-727-0794
Mailing Address - Fax:409-727-6030
Practice Address - Street 1:1120 S 27TH ST
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6224
Practice Address - Country:US
Practice Address - Phone:409-727-0794
Practice Address - Fax:409-727-6030
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7728208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035665101244-1662Medicaid
TXJ7728OtherLICENSE
TX340009803OtherRAIL ROAD MEDICARE
TX035665101244-1662Medicaid
TXJ7728OtherLICENSE