Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G7119 | TX |
NPI | 1073559209 |
---|---|
Provider Name | Robert J Wilcott |
First Address | Denison, TX 75020-4589 |
Second Address | Sherman, TX 75090-2881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 09/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043815202 | (05) | TX |
100149090A | (05) | OK |
8GF118 | BCBS OF TX (01) | TX |
E86841 | (02) |