Individual
JOHANNA MOON WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
727 1/2 HENRY CLAY AVE, NEW ORLEANS, LA 70118-5819
(985) 320-5467
Mailing address
1401 FOUCHER ST, NEW ORLEANS, LA 70115-3515
(504) 897-7011
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD.205810
LA
Other
Enumeration date
06/08/2010
Last updated
07/02/2013
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