Individual
TIM I WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5050 NE HOYT ST STE 454, PORTLAND, OR 97213-2984
(503) 215-6405
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD190891
OR
207Q00000X
Family Medicine Physician
RS2007-0387
NM
Other
Enumeration date
06/27/2007
Last updated
12/20/2019
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