Individual
DR. OLIVER JAYME WISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
DERMATOLOGY HEALTH SPCECIALIST, 1693 SW CHANDLER AVE SUITE 250, BEND, OR 97702-3231
(541) 382-8819
Mailing address
15 LA SALLE SQ, PROVIDENCE, RI 02903-1814
(401) 444-6779
(401) 444-6912
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
DO01032
RI
207ND0101X
MOHS-Micrographic Surgery Physician
DO157812
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12729019
CAQH
OR
05
—
500674728
—
OR
Enumeration date
04/06/2007
Last updated
12/19/2025
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