Individual
OLUSEGUN WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 WALLACE BLVD, AMARILLO, TX 79106-1799
(505) 894-2111
(505) 894-7659
Mailing address
PO BOX 840186, DALLAS, TX 75284-0186
(866) 916-5259
(231) 922-4030
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
M3792
TX
207Q00000X
Family Medicine Physician
20050127
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187155001
—
TX
Enumeration date
04/13/2006
Last updated
11/01/2013
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