Provider Demographics
NPI:1750598298
Name:ROBERT D. WILCOX MD PA
Entity type:Organization
Organization Name:ROBERT D. WILCOX MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-620-1700
Mailing Address - Street 1:5316 W 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 W 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:2007-05-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00380VMedicare PIN