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Individual

LESLIE K WILLCOX

Active
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Individual

LESLIE K WILLCOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA C

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10000174A
IN
363A00000X
Physician Assistant
Primary
1418
SC
363A00000X
Physician Assistant
50-00-0523
OH
363AS0400X
Surgical Physician Assistant
1418
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0833PA
—
SC
01
—
970027633
RAILROAD MEDICARE #
—
Enumeration date
08/02/2005
Last updated
05/11/2021
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