Individual
DR. DANIEL H WISSINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1203 RIDGEWAY RD, STE 201, MEMPHIS, TN 38119-5316
(901) 761-5544
(901) 761-9088
Mailing address
1203 RIDGEWAY RD, STE 201, MEMPHIS, TN 38119-5316
(901) 761-5544
(901) 761-9088
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD20384
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015301
MS MEDICAID
MS
01
—
0103677
BLUE CROSS BLUE SHIELD
TN
01
—
0840400
UNITED HEALTCARE
—
05
—
3050594
—
TN
Enumeration date
05/27/2005
Last updated
07/09/2007
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