Provider Demographics
NPI:1790815512
Name:WILDER, ERROL P (MD)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:P
Last Name:WILDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6711
Practice Address - Street 1:771 BAYOU PINES EAST DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7183
Practice Address - Country:US
Practice Address - Phone:337-433-1212
Practice Address - Fax:337-433-0736
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2017-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAMD200582207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1073784Medicaid
P00417420Medicare PIN
4K6397460Medicare PIN