Provider Demographics
NPI:1003921172
Name:WILDE, JAMES OSCAR JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:OSCAR
Last Name:WILDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S. MARKET ST.
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921
Mailing Address - Country:US
Mailing Address - Phone:662-625-7118
Mailing Address - Fax:662-647-8954
Practice Address - Street 1:201 S. MARKET ST.
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921
Practice Address - Country:US
Practice Address - Phone:662-625-7118
Practice Address - Fax:662-647-8954
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23852207Q00000X
MS22475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine