Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | J7728 | TX |
NPI | 1033192901 |
---|---|
Provider Name | Dr. Moses Edward Wilcox SR. |
First Address | Nederland, TX 77627-6224 |
Second Address | Nederland, TX 77627-6224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035665101244-1662 | (05) | TX |
340009803 | RAIL ROAD MEDICARE (01) | TX |
B60667 | (02) | |
J7728 | LICENSE (01) | TX |