Organization
T. PAUL WILDER, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA KAY STONE (OFFICE ASSISTANT)
(270) 827-8662
Entity
Organization
Contact information
Practice address
319 8TH ST, STE 4, HENDERSON, KY 42420-2963
(270) 827-8662
(270) 826-8220
Mailing address
319 8TH ST, STE 4, HENDERSON, KY 42420-2963
(270) 827-8662
(270) 826-8220
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15950
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000612983
ANTHEM BLUE SHIELD
KY
05
—
64159502
—
KY
Enumeration date
11/01/2007
Last updated
06/15/2009
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