Individual
DR. GILBERT M WILCOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
161 MARGINAL WAY, PORTLAND, ME 04101-2438
(207) 773-7964
(207) 773-9073
Mailing address
161 MARGINAL WAY, PORTLAND, ME 04101-2438
(207) 774-3461
(207) 774-3463
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0102139
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01-0418797
FEDERAL TAX ID
ME
01
—
037916
ANTHEM STAR NUMBER
ME
01
—
100003458
RAILROAD MEDICARE
ME
05
—
117070000
—
ME
01
—
E001889
TRICARE
ME
Enumeration date
12/27/2006
Last updated
12/23/2019
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