Provider Demographics
NPI:1841271376
Name:WILEY, DAVID ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:WILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:125 S PARK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5952
Mailing Address - Country:US
Mailing Address - Phone:325-641-2384
Mailing Address - Fax:325-641-0418
Practice Address - Street 1:125 S PARK DR
Practice Address - Street 2:SUITE E
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5952
Practice Address - Country:US
Practice Address - Phone:325-641-2384
Practice Address - Fax:325-641-0418
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL3184208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152022301Medicaid
TX152022301Medicaid
H58794Medicare UPIN