Individual
BRADLEY E WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
411 LAUREL ST STE A120, DES MOINES, IA 50314-3027
(515) 643-7900
(515) 643-7901
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-7900
(515) 643-7901
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
102479
MN
207RP1001X
Pulmonary Disease Physician
49087
MN
207RP1001X
Pulmonary Disease Physician
Primary
DO-03941
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
841652000
—
MN
Enumeration date
07/19/2006
Last updated
11/11/2020
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