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
Fax: (406) 752-3542
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922021518 NPPES
Montana MEDICAID 0032344
Montana Other 08110

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