Individual
BENJAMIN B WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1405 HOWELL, WORLAND, WY 82401
(307) 347-2555
(307) 347-9831
Mailing address
1405 HOWELL, WORLAND, WY 82401
(307) 347-2555
(307) 347-9831
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8661A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295997013
—
WY
Enumeration date
07/02/2008
Last updated
12/19/2013
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