Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 7771656-1205 | UT |
NPI | 1033344767 |
---|---|
Provider Name | Ryan Eldredge Wilcox |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Cedar City, UT 84721-9746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 04/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01103290 | MEDICARE RAILROAD (01) | MN |