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NPI Code Detail

MEDICARE: JAMES WILD MD

MEDICARE:   JAMES  WILD  MD
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
1207RR0500XRheumatology PhysicianE4114TX

General Provider Information

NPI Number : 1659343291
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES WILD MD
Provider Business Mailing Address
First Line : PO BOX 2207
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78298-2207
Country : US
Telephone Number : 210-615-9990
Fax Number : 210-615-9909
Provider Business Practice Location Address
First Line : 14615 SAN PEDRO
Second Line : STE # 105
City : SAN ANTONIO
State : TX
Zip : 78232-4321
Country : US
Telephone Number : 210-404-0020
Fax Number : 210-404-0325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2006
Last Update Date : 07/09/2007

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Directions to “ JAMES WILD MD” Practice Location

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