Provider Demographics
NPI:1356391833
Name:WICKER, JOSEPH BEAMAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BEAMAN
Last Name:WICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOORE
Other - Middle Name:COUNTY
Other - Last Name:ANESTHESIA ASSOCIATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5249
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-5249
Mailing Address - Country:US
Mailing Address - Phone:910-295-2920
Mailing Address - Fax:910-295-4640
Practice Address - Street 1:45 CANTER LN
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8666
Practice Address - Country:US
Practice Address - Phone:910-295-2920
Practice Address - Fax:910-295-4640
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26166207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC87317OtherBCBS OF NC
NC8987269Medicaid
SCQ26166Medicaid
NC1323XOtherBC OF NC STATE HEALTH PLA
NC8987269Medicaid
NC87317OtherBCBS OF NC
NC211515DMedicare ID - Type Unspecified