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General NPI Number Information
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NPI Number | 1023306933
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Entity Type | Individual
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Provider Name | TROY SCOTT WILDE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1012 E WILLETTA ST
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City | PHOENIX
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State | AZ
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Zip | 85006-2749
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Country | US
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Telephone | 602-839-6484
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Fax |
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Provider Business Mailing Address
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Address Line | 19411 E REINS RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8628
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Country | US
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Telephone | 972-951-9691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0792
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License Number State | AZ
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