Individual
DR. DARRELL WALLACE WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9250 PINECROFT DR, SHENANDOAH, TX 77380-3218
(281) 364-5805
(281) 364-5875
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
P3485
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP10035402-ID#540187
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324224001
—
TX
05
—
324224002
—
TX
01
—
8DY159
BLUE CROSS BLUE SHIELD
TX
01
—
P01237859
RAILROAD MEDICARE
TX
Enumeration date
08/10/2009
Last updated
05/07/2020
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