Basic Information
| Provider Information | |||||||||
| NPI: | 1619195641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILFORD | ||||||||
| FirstName: | REX | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 ARCH ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753315 | ||||||||
| FaxNumber: | 3303753760 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 ARCH ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753315 | ||||||||
| FaxNumber: | 3303753760 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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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 | 207R00000X | 34008777 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2776689 | 05 | OH | MEDICAID | 4208392 | 01 | OH | MEDICARE ID | OTHER |