Individual
ALONZO WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
13960 FLORIDA BLVD, LIVINGSTON, LA 70754
(225) 686-0158
Mailing address
PO BOX 261166, BATON ROUGE, LA 70826-1166
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
A10241
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1626716
—
LA
Enumeration date
06/09/2006
Last updated
01/27/2009
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