Individual
DR. DAVID WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
150 W UNIVERSITY BLVD, MELBOURNE, FL 32901-6982
(321) 674-7516
Mailing address
150 W UNIVERSITY BLVD, MELBOURNE, FL 32901-6982
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-00-0072
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-00-0072
BEHAVIOR ANALYSIS CERTIFICAITON BOARD
FL
01
—
686259496
MEDICAID DD WAIVER
FL
Enumeration date
12/14/2009
Last updated
12/14/2009
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