Provider Demographics
NPI:1427290949
Name:WILCOX, CARRIE ELIZABETH
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4943 STATE HIGHWAY 52
Mailing Address - Street 2:STE 240
Mailing Address - City:DACONO
Mailing Address - State:CO
Mailing Address - Zip Code:80514-9100
Mailing Address - Country:US
Mailing Address - Phone:303-501-2600
Mailing Address - Fax:
Practice Address - Street 1:4943 STATE HIGHWAY 52
Practice Address - Street 2:STE 240
Practice Address - City:DACONO
Practice Address - State:CO
Practice Address - Zip Code:80514-9100
Practice Address - Country:US
Practice Address - Phone:303-501-2600
Practice Address - Fax:303-833-7017
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049758207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00326697Medicaid
CO00326697Medicaid