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
Phone: (520) 255-5475
Fax: (855) 801-7998
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073703310 | NPPES |
| Arizona | MEDICAID | 613078 |
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