Wilde, Jeffrey Virgil

Wilde, Jeffrey Virgil is an sole proprietor health care provider with primary practice located at 302 El Camino Real Bldg 11 , Sierra Vista AZ 85635-2860. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wilde, Jeffrey Virgil can be contacted via phone (520) 255-5475.

Contact Information

Primary practice address
302 El Camino Real Bldg 11 Sierra Vista AZ 85635-2860
Fax: (855) 801-7998
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 44157 Arizona

Profile Details

NPI number 1073703310
LBN Legal business name Wilde, Jeffrey Virgil
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 1st, 2007
Last updated Mar 18th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073703310 NPPES
Arizona MEDICAID 613078

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