Provider Demographics
NPI:1609076637
Name:WILLCOX, NEVENA PAVLOVIC (MD)
Entity Type:Individual
Prefix:DR
First Name:NEVENA
Middle Name:PAVLOVIC
Last Name:WILLCOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1650 W COLLEGE ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3565
Mailing Address - Country:US
Mailing Address - Phone:817-388-3440
Mailing Address - Fax:817-388-3441
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:817-388-3440
Practice Address - Fax:817-388-3441
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ4708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440163501OtherAR MEDICAID TEMP RX NUMBE