Individual
JOHN A WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3005
NC
103TC0700X
Clinical Psychologist
P3005
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000785
—
NC
01
—
P00316181
RR MEDICARE # - PARADIGM
NC
Enumeration date
10/04/2006
Last updated
02/27/2020
Update your record
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