Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 24876 | AZ |
NPI | 1063470623 |
---|---|
Provider Name | Lori-Ann R Wilcox |
First Address | Peoria, AZ 85381-3687 |
Second Address | Peoria, AZ 85381-3687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 26/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070010475 | RAILROAD MEDICARE (01) | AZ |
1017047 | AETNA (01) | AZ |
1063470623 | AHCCCS (01) | AZ |
1726808 | UNITED HEALTHCARE (01) | AZ |
188961600 | DEPT OF LABOR WORK COMP (01) | AZ |
1Z3908 | HEALTH NET (01) | AZ |
379736 | (05) | AZ |
99S007000009 | MEDISUN (01) | AZ |
AZ0804410 | BLUE CROSS BLUE SHIELD (01) | AZ |
G43583 | (02) | |
WCKLL05 | MEDICARE ID (01) |