Provider Demographics
NPI:1609932557
Name:ROBERT D. WILCOX MD PA
Entity Type:Organization
Organization Name:ROBERT D. WILCOX MD PA
Other - Org Name:PLASTIC AND COSMETIC SURGERY CENTER OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIBBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-620-1700
Mailing Address - Street 1:5316 WEST PLANO PARKWAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4821
Mailing Address - Country:US
Mailing Address - Phone:972-620-1700
Mailing Address - Fax:972-248-2333
Practice Address - Street 1:5316 WEST PLANO PARKWAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4821
Practice Address - Country:US
Practice Address - Phone:972-620-1700
Practice Address - Fax:972-248-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007155261QA1903X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1531OtherBLUE CROSS BLUE SHIELD
TX007155OtherWORKERS COMPENSATION
TXASC094Medicare PIN