Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0792 | AZ |
NPI | 1023306933 |
---|---|
Provider Name | Dr. Troy Scott Wilde |
First Address | Queen Creek, AZ 85142-8628 |
Second Address | Phoenix, AZ 85006-2749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 22/06/2020 |