Provider Information for 1720735707
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THOMAS PERRY WILDER
Sex: Male
NPI: 1720735707
Last Updated: 2022-03-09
Certification Date: 2022-03-09
Certification Date: 2022-03-09
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1720735707 | ||||||||
| Enumeration Date | 2022-03-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 320 MOUNTAIN CREST RD SWANNANOA, NC 28778-2314 United States Phone: 828-899-0007 | Fax: | ||||||||
| Primary Practice Address | 320 MOUNTAIN CREST RD SWANNANOA, NC 28778-2314 United States Phone: 828-899-0007 | Fax: | ||||||||
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