Individual
DR. THEARON PAUL WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1997 BARRETT CT, HENDERSON, KY 42420-2667
(270) 827-8662
(270) 826-8220
Mailing address
PO BOX 1079, HENDERSON, KY 42419-1079
(270) 827-0353
(270) 827-4966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15950
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64159502
—
KY
Enumeration date
07/06/2005
Last updated
03/11/2013
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