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Contact Information

ALONZO WILDER, PAC
13960 FLORIDA BLVD
LIVINGSTON, LA70754
 Phone: 225-686-0158
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for ALONZO WILDER · (Male)

NPI # 1881635878
Status Active
Credentials PAC
Entity Individual
Enumeration date 06/09/2006
Last updated 01/27/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • LA License # A10241
  • LA Medicaid 1626716
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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