Provider Demographics
NPI:1881696516
Name:WILCOX, DALLAS C JR (MD)
Entity type:Individual
Prefix:DR
First Name:DALLAS
Middle Name:C
Last Name:WILCOX
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:307 E MEIGHAN BLVD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1048
Mailing Address - Country:US
Mailing Address - Phone:256-543-2273
Mailing Address - Fax:256-543-2293
Practice Address - Street 1:307 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1048
Practice Address - Country:US
Practice Address - Phone:256-543-2273
Practice Address - Fax:256-543-2293
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-06-10
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Provider Licenses
StateLicense IDTaxonomies
AL17696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51077710OtherBLUE CROSS/BLUE SHIELD
AL000077710Medicare PIN
ALG61316Medicare UPIN