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General NPI Number Information
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NPI Number | 1164628418
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Entity Type | Individual
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Provider Name | DAVID M WILD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 811 S MILAM ST
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4789
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Country | US
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Telephone | 314-604-4618
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7909
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City | LONGVIEW
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State | TX
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Zip | 75607-7909
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Country | US
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Telephone | 314-604-4618
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | W1713
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 04-35744
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License Number State | KS
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