Individual
MYRA CLAVIER WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
424 W MCNEESE ST, LAKE CHARLES, LA 70605-5547
(337) 478-0511
(337) 478-5644
Mailing address
424 W MCNEESE ST, LAKE CHARLES, LA 70605-5547
(337) 478-0511
(337) 478-5644
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
018805
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1460206
—
LA
Enumeration date
03/19/2007
Last updated
10/13/2016
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