Healthcare Provider Details

I. General information

NPI: 1447218698
Provider Name (Legal Business Name): SUSAN S WILDER M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

IV. Provider business mailing address

8757 E BELL RD
SCOTTSDALE AZ
85260-1322
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-5500
  • Fax: 480-860-5260
Mailing address:
  • Phone: 480-860-5500
  • Fax: 480-860-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23132
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: