Provider Demographics
NPI:1417931007
Name:WILLCOX, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:WILLCOX
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 1:5005 MAIN ST STE 125
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-3177
Mailing Address - Country:US
Mailing Address - Phone:253-759-4522
Mailing Address - Fax:360-598-7505
Practice Address - Street 1:5005 MAIN ST STE 125
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-3177
Practice Address - Country:US
Practice Address - Phone:253-759-4522
Practice Address - Fax:360-598-7505
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000421482086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0261603OtherSTATE L&I
WA0266417OtherSTATE L&I
WA1009933Medicaid
WA198792OtherDEPT OF LABOR & INDUSTRY
WA0251801OtherSTATE L&I
WA0261603OtherSTATE L&I
WA0251801OtherSTATE L&I
WA0266417OtherSTATE L&I
WA1118041Medicaid