Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 15114 | TX |
NPI | 1003897257 |
---|---|
Provider Name | Dr. Patrick B Wilcox |
First Address | Edinburg, TX 78539-8463 |
Second Address | Edinburg, TX 78539-8463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 29/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120793801 | (05) | TX |
U11922 | (02) |