Individual
DR. BRIAN M WICKWIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 N GARZA ST STE A, RIO GRANDE CITY, TX 78582
(956) 487-0846
Mailing address
PO BOX 1689, PHARR, TX 78577-1630
(956) 787-0787
(956) 787-2021
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L3524
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154778801
—
TX
Enumeration date
07/11/2005
Last updated
08/31/2018
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