JEFFREY WILDE MD PLLC NPI 1518515683

NPI Information

  • NPI: 1518515683
  • Provider Name: JEFFREY WILDE MD PLLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • :
  • CLIA Number: 03D2018487
  • Address: 302 EL CAMINO REAL BLDG 11
    SIERRA VISTA, AZ
    ZIP 85635
  • Phone: (520) 255-5475

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NPI Details

JEFFREY WILDE MD PLLC is a family medicine in Sierra Vista, AZ. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. JEFFREY WILDE MD PLLC NPI is 1518515683. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider .

The provider's business location address is:

302 EL CAMINO REAL BLDG 11
SIERRA VISTA, AZ
ZIP 85635-860
Phone: (520) 255-5475
Fax: (855) 801-7998

The provider's authorized official is Jeffrey Virgil Wilde .
The authorized official title is Physician/owner and has the following contact phone number (520) 255-5475.

The CLIA number assigned to this NPI record is 03D2018487 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/30/2019 and was last updated on 3/7/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1552797MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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