Individual
DENISE KATHLEEN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
800 5TH AVE, SUITE 400, FORT WORTH, TX 76104-7300
(817) 924-1999
(817) 886-0881
Mailing address
800 5TH AVE, SUITE 400, FORT WORTH, TX 76104-7300
(817) 924-1999
(817) 886-0881
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A74394
CA
2085R0202X
Diagnostic Radiology Physician
Primary
K3002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A743940
—
CA
05
—
104612003
—
TX
05
—
104612005
—
TX
Enumeration date
08/08/2006
Last updated
02/11/2015
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