Organization
JENNINGS INTERNAL MEDICINE ASSOCIATES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN C WILDER MD (PRESIDENT)
(337) 824-9119
Entity
Organization
Contact information
Practice address
1902 JOHNSON ST, JENNINGS, LA 70546
(337) 824-9119
(337) 824-7005
Mailing address
1902 JOHNSON ST, JENNINGS, LA 70546
(337) 824-9119
(337) 824-7005
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1948942
—
LA
Enumeration date
10/03/2006
Last updated
03/28/2011
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