Individual
LORI-ANN R WILCOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13943 N 91ST AVE, C-101, PEORIA, AZ 85381-3687
(623) 760-9449
(623) 974-9351
Mailing address
13943 N 91ST AVE, C-101, PEORIA, AZ 85381-3687
(623) 760-9449
(623) 974-9351
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
24876
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070010475
RAILROAD MEDICARE
AZ
01
—
1017047
AETNA
AZ
01
—
1063470623
AHCCCS
AZ
01
—
1726808
UNITED HEALTHCARE
AZ
01
—
188961600
DEPT OF LABOR WORK COMP
AZ
01
—
1Z3908
HEALTH NET
AZ
05
—
379736
—
AZ
01
—
99S007000009
MEDISUN
AZ
01
—
AZ0804410
BLUE CROSS BLUE SHIELD
AZ
01
—
WCKLL05
MEDICARE ID
—
Enumeration date
05/03/2006
Last updated
01/26/2016
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