Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2009007880 | MO |
N | 207QA0505X | Family Doctor - Adult Medicine | 11588 | NV |
N | 207QA0505X | Family Doctor - Adult Medicine | 6968998-1205 | UT |
N | 207QA0505X | Family Doctor - Adult Medicine | MD033724E | PA |
NPI | 1205890027 |
---|---|
Provider Name | Simmon L Wilcox |
First Address | Las Vegas, NV 89107-1268 |
Second Address | Las Vegas, NV 89104-5525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000185023 | HIGHMARK BC/BS (01) | PA |
100510116 | (05) | NV |
A60333 | (02) | PA |