| NPI | 1467335737 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY VIRGIL WILDE Md/Practice Owner 520-255-5475 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-07-28 |