Individual
DR. JOHN RICHARDSON WILCOX JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4777 US HIGHWAY 259, LONGVIEW, TX 75605-7668
(903) 663-4800
(903) 663-0378
Mailing address
PO BOX 5316, LONGVIEW, TX 75608-5316
(903) 663-4800
(903) 663-0378
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
F0824
TX
2085R0204X
Vascular & Interventional Radiology Physician
F0824
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134263610
—
TX
05
—
134263613
—
TX
01
—
8DB361
BCBS TX
TX
01
—
P00995222
RR MEDICARE
TX
Enumeration date
05/31/2005
Last updated
06/22/2012
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