Provider Demographics
NPI:1538363312
Name:DENNIS D. WILCOX, M.D., INC.
Entity type:Organization
Organization Name:DENNIS D. WILCOX, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-822-2279
Mailing Address - Street 1:3800 JANES RD
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-4742
Mailing Address - Country:US
Mailing Address - Phone:707-822-2279
Mailing Address - Fax:707-825-4988
Practice Address - Street 1:3800 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4742
Practice Address - Country:US
Practice Address - Phone:530-241-1473
Practice Address - Fax:707-825-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538363312Medicaid
CA=========OtherEIN
CA1538363312Medicare PIN