Individual
DR. STEPHEN R. WILT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
4809 AMBASSADOR CAFFERY PKWY, SUITE 100, LAFAYETTE, LA 70508-8800
(337) 769-8660
(337) 769-8661
Mailing address
4809 AMBASSADOR CAFFERY PKWY, STE 100, LAFAYETTE, LA 70508-8800
(337) 769-8660
(337) 769-8661
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
10351R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10351R
STATE MEDICAL LICENSE
LA
05
—
1986739
—
LA
01
—
5DX68
ONCOLOGICS LLC GROUP PTAN MEDICARE EFFECTIVE 05/19/2012
LA
01
—
5U307DX68
STEPHEN WILT PTAN MEDICARE EFFECTIVE 05/19/2012
LA
01
—
PTAN 381631ZLAC
LINKED TO GROUP PTAN 381439 EFFECTIVE 10-31-14
LA
Enumeration date
07/26/2006
Last updated
06/29/2020
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