Provider Demographics
NPI:1043252901
Name:WILDER, JAMES FRANKLIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANKLIN
Last Name:WILDER
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3415 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-6981
Practice Address - Country:US
Practice Address - Phone:903-727-2200
Practice Address - Fax:903-727-2209
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK17252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S7050OtherBLUE CROSS OF TEXAS
TX119039908Medicaid
NM18621856Medicaid
TX119039907Medicaid
TX119039909Medicaid
TX119039906Medicaid
TX8S7050OtherBLUE CROSS OF TEXAS
TX8J4780Medicare PIN
TX900001239Medicare PIN
TXF24374Medicare UPIN
TX8D8389Medicare PIN
TX119039907Medicaid