Individual
DAVID WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 COX BLVD, GOLDSBORO, NC 27534-9479
(919) 735-7580
(919) 580-9338
Mailing address
201 COX BLVD, GOLDSBORO, NC 27534-9479
(919) 735-7580
(919) 580-9338
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
102519
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136YA
BCBS
NC
05
—
89130F0
—
NC
Enumeration date
02/08/2007
Last updated
08/09/2012
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