Active NPI
William J Wilder, MD
- Dermatology Physician
- Houma, LA
National Provider Identifier
1053374884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 011220
- Practice address
- 12 Professional Drive
Houma, LA 70360 - Phone
- (985) 868-1810
- Fax
- (985) 876-3670
- NPI assigned
- Apr 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 011220 | LA | Primary |
Addresses
Primary practice location
12 Professional Drive
Houma, LA 70360
Mailing address
12 Professional Drive
Houma, LA 70360
Phone (985) 868-1810
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119241 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011220 | LA | MD | Dermatology Physician |
Interoperability endpoints
- wwilder408204@direct.ochsner.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272326400000",
"number": "1053374884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 PROFESSIONAL DRIVE",
"city": "HOUMA",
"state": "LA",
"postal_code": "70360",
"telephone_number": "985-868-1810",
"fax_number": "985-876-3670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 PROFESSIONAL DRIVE",
"city": "HOUMA",
"state": "LA",
"postal_code": "70360",
"telephone_number": "985-868-1810",
"fax_number": "985-876-3670"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "WILLIAM",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-11",
"last_updated": "2010-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "LA",
"license": "011220",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "119241",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houma, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.