Provider Demographics
NPI:1932229606
Name:NORMAN J. WILDER, M.D.
Entity Type:Organization
Organization Name:NORMAN J. WILDER, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-346-3478
Mailing Address - Street 1:PO BOX 241769
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1769
Mailing Address - Country:US
Mailing Address - Phone:907-770-2380
Mailing Address - Fax:907-770-2325
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:907-346-3478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty