Provider Demographics
NPI:1467335737
Name:JEFFREY WILDE MD PLLC
Entity type:Organization
Organization Name:JEFFREY WILDE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-255-5475
Mailing Address - Street 1:302 EL CAMINO REAL STE 11A
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2825
Mailing Address - Country:US
Mailing Address - Phone:520-255-5475
Mailing Address - Fax:
Practice Address - Street 1:75 COLONIA DE SALUD STE 200B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2486
Practice Address - Country:US
Practice Address - Phone:520-255-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERY WILDE MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty