Individual
STEVEN RAY WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1435 S UTICA AVE, TULSA, OK 74104-4649
(918) 392-4900
Mailing address
PO BOX 108809, OKLAHOMA CITY, OK 73101-8809
(918) 299-8232
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18226
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100089420C
—
OK
Enumeration date
08/30/2006
Last updated
07/08/2007
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