Individual
WALLACE S WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 SUNNYVIEW LN, SUITE 103, KALISPELL, MT 59901-3135
(406) 752-8300
(406) 752-3542
Mailing address
210 SUNNYVIEW LN, SUITE 103, KALISPELL, MT 59901-3135
(406) 752-8300
(406) 752-3542
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3655
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0032344
—
MT
01
—
08110
BLUE CROSS
MT
Enumeration date
07/25/2006
Last updated
07/08/2007
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