Individual
DR. TANYA MARYA WILDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 ENTRANCE WAY, SAINT PETERS, MO 63376-1645
(636) 996-3360
(636) 916-9176
Mailing address
660 S EUCLID AVE, C B 8056, SAINT LOUIS, MO 63110-1010
(314) 747-1171
(314) 362-3192
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
2009005695
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659592152
—
MO
05
—
ENROLLED
—
IL
Enumeration date
05/01/2007
Last updated
01/29/2018
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