| Doctor Name: | MR. RICHARD M WILCOX |
| NPI Number: | 1497948780 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CERTIFIED MASTECOMY |
| License Number: | |
| Business Practice Address: | 2322 Midway Dr Santa Rosa, CA - 95405 |
| Business Phone Number: | 7075423941 |
| Business Fax Number: | 7075423935 |
| Mailing Address: | 2322 Midway Dr, SANTA ROSA |
| State: | CA |
| Postal Code: | 95405 |
| Phone Number: | 7075423941 |
| Fax Number: | 7075423935 |
| NPI Enumeration Date: | 08/21/2007 |
| NPI Last Update Date: | 04/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |