Provider Demographics
NPI:1942213392
Name:WILDER, CYNTHIA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:KAY
Last Name:WILDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3417 GASTON AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2031
Mailing Address - Country:US
Mailing Address - Phone:972-993-5000
Mailing Address - Fax:972-993-5001
Practice Address - Street 1:3900 JUNIUS ST STE 415
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1617
Practice Address - Country:US
Practice Address - Phone:972-993-8300
Practice Address - Fax:972-993-8301
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165931002Medicaid
TX8A0787OtherBCBS
TX8A0787OtherBCBS
TXI10244Medicare UPIN
TXP00349182Medicare PIN