Active NPI
Glenn Lockhart Wilcox, DOM
- General Practice Physician
- Albuquerque, NM
National Provider Identifier
1720141286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 34RX2
- Practice address
- 5353 Wyoming Blvd NE
Suite 4
Albuquerque, NM 87109-3132 - Phone
- (505) 771-4998
- NPI assigned
- Dec 18, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 34RX2 | NM | Primary |
Addresses
Primary practice location
5353 Wyoming Blvd NE
Suite 4
Albuquerque, NM 87109-3132
Mailing address
5353 Wyoming Blvd NE
Suite 4
Albuquerque, NM 87109-3132
Phone (505) 771-4998
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34RX2 | NM | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393286400000",
"number": "1720141286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5353 WYOMING BLVD NE",
"address_2": "SUITE 4",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871093132",
"telephone_number": "505-771-4998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5353 WYOMING BLVD NE",
"address_2": "SUITE 4",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871093132",
"telephone_number": "505-771-4998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILCOX",
"first_name": "GLENN",
"middle_name": "LOCKHART",
"credential": "DOM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-18",
"last_updated": "2014-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NM",
"license": "34RX2",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.