Provider Demographics
NPI:1821651357
Name:WILDER, SCOTT DAVID (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVID
Last Name:WILDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5639
Mailing Address - Country:US
Mailing Address - Phone:916-897-0681
Mailing Address - Fax:
Practice Address - Street 1:911 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5639
Practice Address - Country:US
Practice Address - Phone:916-897-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program