Individual
GARRY WAYNE WICKLIFFE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSA, CST
Contact information
Practice address
704 S FLEISHEL AVE, TYLER, TX 75701-2014
(903) 646-5350
Mailing address
2320 KAYNELL DR, HENDERSON, TX 75654-4718
(936) 635-3169
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
SA00957
TX
Other
Enumeration date
03/11/2021
Last updated
03/31/2024
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