Provider Demographics
NPI:1205362407
Name:ROBERT D. WILCOX, MD, PA
Entity Type:Organization
Organization Name:ROBERT D. WILCOX, MD, PA
Other - Org Name:PLANO CENTER FOR SURGICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-422-0641
Mailing Address - Street 1:5316 W PLANO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4821
Mailing Address - Country:US
Mailing Address - Phone:972-620-1700
Mailing Address - Fax:972-248-2333
Practice Address - Street 1:5316 W PLANO PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4821
Practice Address - Country:US
Practice Address - Phone:972-620-1700
Practice Address - Fax:972-248-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007155261QA1903X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical