Provider Demographics
NPI:1982965620
Name:RAYNES WILDER, CARA K (MD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:K
Last Name:RAYNES WILDER
Suffix:
Gender:F
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 338
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-0338
Mailing Address - Country:US
Mailing Address - Phone:828-285-0622
Mailing Address - Fax:828-348-2025
Practice Address - Street 1:257 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4120
Practice Address - Country:US
Practice Address - Phone:828-285-0622
Practice Address - Fax:828-348-2025
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20695207Q00000X
NC2018-03023207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILP02528OtherRHODE ISLAND LICENSE NUMBER