Individual
RICHARD BARRY WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-1075
(813) 745-7231
Mailing address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-1075
(813) 745-7231
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
ME105988
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G709070
—
CA
01
—
5780708
AETNA PIN
CA
01
—
P00796215
RAILROAD MEDICARE
CA
Enumeration date
01/17/2007
Last updated
06/10/2014
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