Provider Demographics
NPI:1235526518
Name:WILLCOCKSON, JAMES RYAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RYAN
Last Name:WILLCOCKSON
Suffix:
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 1:283 E EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2584
Mailing Address - Country:US
Mailing Address - Phone:402-681-4058
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PLASTIC SURGERY, SUITE T2600
Practice Address - Street 2:1155 N MAYFAIR ROAD
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-955-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program