Provider Demographics
NPI:1518918507
Name:WILCOX, CARVER GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARVER
Middle Name:GREGORY
Last Name:WILCOX
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 1:302 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-621-1000
Mailing Address - Fax:808-621-9676
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-621-1000
Practice Address - Fax:808-621-9676
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF58603Medicare UPIN
HI0000BDXFGMedicare ID - Type UnspecifiedPROVIDER NUMBER