Wilder, Wallace S
Wilder, Wallace S is an sole proprietor health care provider with primary practice located at 210 Sunnyview Ln Suite 103, Kalispell MT 59901-3135. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Wilder, Wallace S can be contacted via phone (406) 752-8300.Contact Information
Primary practice address
210 Sunnyview Ln Suite 103
Kalispell MT 59901-3135
Phone: (406) 752-8300
Fax: (406) 752-3542
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 3655 | Montana |
Profile Details
| NPI number | 1922021518 |
|---|---|
| LBN Legal business name | Wilder, Wallace S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 25th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 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 | 1922021518 | NPPES |
| Montana | MEDICAID | 0032344 | |
| Montana | Other | 08110 |
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