Individual
WILLIAM JASON WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ST
Contact information
Practice address
711 N TAYLOR ST, GUNNISON, CO 81230-2243
(970) 641-4355
(970) 641-0377
Mailing address
711 N TAYLOR ST, GUNNISON, CO 81230-2243
(970) 641-4355
(970) 641-0377
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
1429
CO
Other
Enumeration date
10/10/2011
Last updated
10/10/2011
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