Healthcare Provider Details

I. General information

NPI: 1891254645
Provider Name (Legal Business Name): ABNER DAVID WILDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

IV. Provider business mailing address

2001 KINGSLEY AVE
ORANGE PARK FL
32073-5148
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME168719
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME168719
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: