Provider Demographics
NPI:1982835385
Name:WILDING, VICTORIA CHLARSON (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:CHLARSON
Last Name:WILDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-4343
Mailing Address - Fax:208-367-7667
Practice Address - Street 1:1055 N CURTIS ROAD
Practice Address - Street 2:SOUTH TOWER, 6 WEST
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-367-4343
Practice Address - Fax:208-367-7667
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-12470207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine