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NPI Code Detail

MEDICARE: WILDER E DIAZ-CALDERON M.D.

MEDICARE: WILDER E DIAZ-CALDERON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianM5130TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00771456OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285697656
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILDER E DIAZ-CALDERON M.D.
Provider Business Mailing Address
First Line : P.O. BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-740-8516
Provider Business Practice Location Address
First Line : 5612 EDWARDS RANCH RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4145
Country : US
Telephone Number : 817-820-0090
Fax Number : 817-377-6566
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2006
Last Update Date : 08/15/2023

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Directions to “ WILDER E DIAZ-CALDERON M.D.” Practice Location

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