Organization
DR DAVID S WISE PA
Active
Organization
DR DAVID S WISE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID S WISE M.D. (PRESIDENT)
(210) 258-5009
Entity
Organization
Contact information
Practice address
11606 MILL ROCK RD, SAN ANTONIO, TX 78230-2762
(210) 258-5009
Mailing address
PO BOX 460625, SAN ANTONIO, TX 78246-0625
(210) 258-5009
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
H8963
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P000204D8
—
TX
Enumeration date
11/08/2016
Last updated
11/08/2016
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