Organization
BOYD R WICKIZER MD LLC
Active
Other names
Dr. Wickizer
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOYD R WICKIZER MD (PRESIDENT)
(804) 938-0264
Entity
Organization
Contact information
Practice address
2802 OTTERDALE RD, MIDLOTHIAN, VA 23112-5408
(804) 938-0264
Mailing address
PO BOX 446, MIDLOTHIAN, VA 23113-0446
(804) 938-0264
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
0101047692
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750330353
—
VA
Enumeration date
07/06/2017
Last updated
07/06/2017
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