Individual
DR. BARRY R WISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5823 W EUGIE AVE, STE A, GLENDALE, AZ 85304-1276
(602) 843-1265
(602) 843-1297
Mailing address
3707 N 7TH ST, #305, PHOENIX, AZ 85014-5059
(602) 264-9100
(602) 264-9101
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
2029
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120390
GROUP MEDICARE NUMBER
AZ
05
—
290445 02
—
AZ
05
—
290445-06
—
AZ
01
—
317047
GROUP MEDICAID NUMBER
AZ
Enumeration date
03/07/2006
Last updated
05/21/2008
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