Provider Demographics
NPI:1588982672
Name:WILCOX, DAVE MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:MICHAEL
Last Name:WILCOX
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2149
Mailing Address - Country:US
Mailing Address - Phone:405-422-6337
Mailing Address - Fax:
Practice Address - Street 1:2315 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2149
Practice Address - Country:US
Practice Address - Phone:405-422-6337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK363A00000X
OK1895363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant