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General NPI Number Information
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NPI Number | 1932163565
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Entity Type | Individual
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Provider Name | DANIEL E WILDES D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 717 S HOUSTON AVE STE 400
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City | TULSA
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State | OK
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Zip | 74127-9007
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Country | US
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Telephone | 918-582-7711
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Fax | 918-583-5831
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Provider Business Mailing Address
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Address Line | 5310 E 31ST ST STE 13
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City | TULSA
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State | OK
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Zip | 74135-5013
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Country | US
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Telephone | 918-561-5701
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Fax | 918-561-1173
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 4168
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License Number State | OK
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