Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | G71873 | CA |
NPI | 1023088689 |
---|---|
Provider Name | John Gordon Wilcox |
First Address | Pasadena, CA 91105-2515 |
Second Address | Pasadena, CA 91105-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G71873 | MEDICAL LICENSE (01) | CA |