Provider Demographics
NPI:1386688232
Name:WILCOX, CELESTE ANN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:ANN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3550 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5004
Practice Address - Country:US
Practice Address - Phone:903-785-0031
Practice Address - Fax:903-784-6755
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0571207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200032050AMedicaid
TX156005402Medicaid
TX156005401Medicaid
TX156005403Medicaid
TX8R1589OtherBLUE CROSS OF TEXAS
H77953Medicare UPIN
TX8A3452Medicare PIN
TX156005401Medicaid
TX900004417Medicare PIN
TX8R1589OtherBLUE CROSS OF TEXAS
TX156005402Medicaid