Individual
DR. STUART R WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1579 WILLOW LN, PROVO, UT 84604-2804
(801) 722-4678
Mailing address
1579 WILLOW LN, PROVO, UT 84604-2804
(801) 722-4678
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
161107-1205
UT
Other
Enumeration date
06/19/2008
Last updated
06/19/2008
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