Individual
MR. WILDER KEITH LAFOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
639 BILTMORE AVE, ASHEVILLE, NC 28803-2585
(828) 254-3392
(828) 254-4380
Mailing address
68 SWEETEN CREEK RD, ASHEVILLE, NC 28803-2318
(828) 274-2400
(828) 277-4808
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795380
—
NC
Enumeration date
06/30/2005
Last updated
09/23/2009
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