Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3018 | AZ |
Y | 103T00000X | Psychologist | 3018 | AZ |
NPI | 1003947698 |
---|---|
Provider Name | Dr. Ronald L. Willcoxon |
First Address | Phoenix, AZ 85024-3074 |
Second Address | Phoenix, AZ 85024-3074 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
732728 | (05) | AZ |