Provider Demographics
NPI:1437140985
Name:WILD, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:WILD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1 SCHOOL ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1133
Mailing Address - Country:US
Mailing Address - Phone:716-241-7067
Mailing Address - Fax:833-464-5024
Practice Address - Street 1:1 SCHOOL ST
Practice Address - Street 2:SUITE 107
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1133
Practice Address - Country:US
Practice Address - Phone:716-241-7067
Practice Address - Fax:833-464-5024
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-08-31
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Provider Licenses
StateLicense IDTaxonomies
NY160937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01028606Medicaid
NYB71163Medicare UPIN
NY01028606Medicaid