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Organization
PHILIP R. WISIACKAS, M.D., P.A.
Active
Organization
PHILIP R. WISIACKAS, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP ROBERT WISIACKAS MD (PHYSICIAN)
(936) 653-4223
Entity
Organization
Contact information
Practice address
110 HILL AVE, COLDSPRING, TX 77331-5406
(936) 653-4223
(936) 653-5042
Mailing address
110 HILL AVE, COLDSPRING, TX 77331-5406
(936) 653-4223
(936) 653-5042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F4703
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00FS32
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
08/11/2010
Last updated
04/07/2011
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