Organization
JOHN E. WISE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EDNEY WISE MD (PRESIDENT)
(828) 328-2094
Entity
Organization
Contact information
Practice address
11 13TH AVE NE, SUITE 103, HICKORY, NC 28601-3700
(828) 328-2094
(828) 328-8980
Mailing address
11 13TH AVE NE, SUITE 103, HICKORY, NC 28601-3700
(828) 328-2094
(828) 328-8980
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
11979
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88634
BLUE CROSS BLUE SHIELD NC
NC
05
—
8988634
—
NC
Enumeration date
10/04/2006
Last updated
07/07/2008
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