Wilde, Olusegun

Wilde, Olusegun is an individual health care provider with primary practice located at 1600 Wallace Blvd , Amarillo TX 79106-1799. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Wilde, Olusegun can be contacted via phone (505) 894-2111.

Contact Information

Primary practice address
1600 Wallace Blvd Amarillo TX 79106-1799
Phone: (505) 894-2111
Fax: (505) 894-7659
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 20050127 New Mexico
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X M3792 Texas

Profile Details

NPI number 1467416727
LBN Legal business name Wilde, Olusegun
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 13th, 2006
Last updated Nov 1st, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1467416727 NPPES
Texas MEDICAID 187155001

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