Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD-042070-E | PA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD-042070-E | PA |
NPI | 1093735789 |
---|---|
Provider Name | Dr. Thomas O. Willcox |
First Address | Philadelphia, PA 19107-4204 |
Second Address | Philadelphia, PA 19107-4204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001421099 | (05) | PA |
5599903 | (05) | NJ |