Organization
WILDCREEK FAMILY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIS MAXINE BOYD DO (OWNER)
(775) 673-6681
Entity
Organization
Contact information
Practice address
2125 GREEN VISTA DR, SUITE 106, SPARKS, NV 89431-8545
(775) 673-6681
(775) 673-6682
Mailing address
2125 GREEN VISTA DR, SUITE 106, SPARKS, NV 89431-8545
(775) 673-6681
(775) 673-6682
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002016380
—
NV
01
—
DB9089
RRMEDICARE
NV
Enumeration date
03/06/2007
Last updated
12/06/2012
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