MEDICARE: WILFRED J RADLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	8288	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831305861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILFRED J RADLER M.D.

Provider Business Mailing Address
First Line	:	5653 HIGHWAY 95
Second Line	:	STE A
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-6069
Country	:	US
Telephone Number	:	928-768-2558
Fax Number	:	928-768-2874

Provider Business Practice Location Address
First Line	:	4263 HIGHWAY 68
Second Line	:	STE C
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-8569
Country	:	US
Telephone Number	:	928-565-3939
Fax Number	:	928-565-4111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/15/2014

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