Individual
DR. BRIAN JOHN WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-2372
(704) 355-6692
Mailing address
PO BOX 36351, SOUTHEAST ANESTHESIOLOGY CONSULTANTS PA, CHARLOTTE, NC 28236-6351
(704) 377-5772
(704) 377-3389
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
32068
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
32068
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8987398
—
NC
01
—
TL5107
MEDICAID
SC
Enumeration date
10/10/2005
Last updated
10/22/2007
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