Provider Demographics
NPI:1700846003
Name:WILDER, NORMAN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAMES
Last Name:WILDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241769
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524
Mailing Address - Country:US
Mailing Address - Phone:907-770-2380
Mailing Address - Fax:907-770-2341
Practice Address - Street 1:10201 SIDOROF LANE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6420
Practice Address - Country:US
Practice Address - Phone:907-770-2380
Practice Address - Fax:907-770-2341
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1519207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1519Medicaid
AKBLCFWMedicare ID - Type Unspecified
AKMD1519Medicaid