Individual
JONATHAN ERIC WICKISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7201
(214) 730-5437
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 730-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
M4653
TX
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
M4653
TX
Other
Enumeration date
07/13/2006
Last updated
04/24/2012
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