Provider Demographics
NPI:1184618340
Name:WILCOXSON, DAVID C (MD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:WILCOXSON
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:PO BOX 20490
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0490
Mailing Address - Country:US
Mailing Address - Phone:480-985-1093
Mailing Address - Fax:480-985-0468
Practice Address - Street 1:6750 E BAYWOOD AVE
Practice Address - Street 2:STE 503
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1749
Practice Address - Country:US
Practice Address - Phone:480-654-3303
Practice Address - Fax:480-654-4030
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18169207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ284240Medicaid
AZA20352100OtherBCBS
AZA20352100OtherBCBS
AZ21690Medicare ID - Type Unspecified