Provider Demographics
NPI:1134469455
Name:WILLCOXEN, ROGER (RRT, AE-C)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:WILLCOXEN
Suffix:
Gender:M
Credentials:RRT, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4725
Mailing Address - Country:US
Mailing Address - Phone:575-317-1253
Mailing Address - Fax:575-622-4220
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4725
Practice Address - Country:US
Practice Address - Phone:575-317-1253
Practice Address - Fax:575-622-4220
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2083227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered