Provider Demographics
NPI:1730177486
Name:WILCOX, DENNIS DREWE (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:DREWE
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3412 LETZ AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-9101
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:707-822-2279
Practice Address - Fax:707-825-4988
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44471208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1730177486OtherPERSONAL NPI AS PROVIDER OF SERVICE
CA1538363312Medicaid
CA1538363312Medicaid
CAC35575Medicare UPIN