# WILLIAM WILDER, APMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093032237
- **Authorized official:** MRS. TINA T LEVRON (CLINIC ADMINSTRATOR)
- **Authorized official phone:** (985) 868-1810

## Contact information

- **Practice address:** 12 PROFESSIONAL DR, HOUMA, LA 70360-4046
- **Practice address phone:** (985) 868-1810
- **Practice address fax:** (985) 876-3670
- **Mailing address:** 12 PROFESSIONAL DR, HOUMA, LA 70360-4046
- **Mailing address phone:** (985) 868-1810
- **Mailing address fax:** (985) 876-3670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 11220 | KY | Yes |

## Other

- **Enumeration date:** 04/28/2010
- **Last updated:** 04/28/2010