Provider Demographics
NPI:1740419365
Name:WILDE, MARCIE STARLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:STARLEY
Last Name:WILDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 W CAMELBACK RD STE 10
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3084
Mailing Address - Country:US
Mailing Address - Phone:928-323-8112
Mailing Address - Fax:
Practice Address - Street 1:13840 W CAMELBACK RD STE 10
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-3084
Practice Address - Country:US
Practice Address - Phone:928-323-8112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007073208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice