Organization
MEDWISE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TED WICKSTROM MD (MEDICAL DIRECTOR)
(928) 776-9900
Entity
Organization
Contact information
Practice address
790 GAIL GARDNER WAY, PRESCOTT, AZ 86305-2337
(928) 776-9900
(928) 776-1444
Mailing address
790 GAIL GARDNER WAY, PRESCOTT, AZ 86305-2337
(928) 776-9900
(928) 776-1444
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
21726
AZ
Other
Enumeration date
05/04/2006
Last updated
03/07/2013
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