Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 131403-1 | NY |
NPI | 1124038443 |
---|---|
Provider Name | Guy H Wilcox |
First Address | Utica, NY 13501-1738 |
Second Address | Utica, NY 13501-1738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 26/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B82906 | (02) | NY |