Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 16736 | OK |
NPI | 1316915671 |
---|---|
Provider Name | Robert A Wild |
First Address | Oklahoma City, OK 73117-1039 |
Second Address | Oklahoma City, OK 73104-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/07/2007 |