Healthcare Provider Details

I. General information

NPI: 1821287483
Provider Name (Legal Business Name): JAMES L WILDER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MADISON OAK DR STE #570
SAN ANTONIO TX
78258-3943
US

IV. Provider business mailing address

540 MADISON OAK DR STE #570
SAN ANTONIO TX
78258-3943
US

V. Phone/Fax

Practice location:
  • Phone: 210-402-3700
  • Fax: 210-402-3892
Mailing address:
  • Phone: 210-402-3700
  • Fax: 210-402-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: JAMES LOWELL WILDER
Title or Position: OWNER
Credential: MD
Phone: 210-402-3700