Individual
ALAN P K WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3660 VISTA AVE, STE. 312, SAINT LOUIS, MO 63110
(314) 977-5110
(314) 977-5119
Mailing address
3635 VISTA AVE, P.O. BOX 15250, SAINT LOUIS, MO 63110-2539
(314) 577-8884
(314) 268-5111
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
R9D17
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040004991
RAILROAD MEDICARE
MO
Enumeration date
10/14/2005
Last updated
11/20/2009
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