Basic Information
| Provider Information | |||||||||
| NPI: | 1285697896 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILCOX | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 GEMINI PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142624263 | ||||||||
| FaxNumber: | 6142620822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1210 GEMINI PL STE 200 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432406110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142624263 | ||||||||
| FaxNumber: | 6142620822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35-07-8203-W | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 35078203W | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4326719 | 01 | OH | CIGNA | OTHER |