NPI 1184858045

Timothy Blake Wilder, IDMT

Practitioner Independent Duty Medical Technicians Scott Afb, IL

Practice location

Address: 310 W Losey St, Scott Afb, IL 62225-5250
Phone: (618) 256-8970
Mailing address: 68 Circle Dr, Fairview Heights, IL 62208-3303

Registered specialties

Independent Duty Medical Technicians Primary

Other Service Providers Taxonomy 1710I1003X

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Registry record

NPI: 1184858045
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 May 2009
Record last updated: 7 May 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.