Individual
JOSEPH LEE WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4038 TIMBERLINE RD., SUITE 100, FORT COLLINS, CO 80525
(970) 673-1155
(970) 673-4747
Mailing address
PO BOX 69, TIMNATH, CO 80547
(970) 673-1155
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
55030
CO
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
55030
CO
Other
Enumeration date
07/18/2006
Last updated
06/07/2016
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