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Individual

DR. JASON T. WISEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD, MSPH

Contact information

Practice address
625 N 6TH ST, PHOENIX, AZ 85004-2155
(602) 406-8222
(602) 604-4722
Mailing address
PROVIDER ENROLLMENT 41 MALL ROAD, BURLINGTON, MA 01805-0001

Taxonomy

Speciality
Code
Description
License number
State
2086X0206X
Surgical Oncology Physician
Primary
1015526
MA
2086X0206X
Surgical Oncology Physician
61811
AZ

Other

Enumeration date
06/20/2011
Last updated
05/23/2023
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