Individual
JOHN MELVIN WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2820 NAPOLEON AVE, STE 460, NEW ORLEANS, LA 70115
(504) 897-5121
(504) 897-9743
Mailing address
2820 NAPOLEON AVE, STE 460, NEW ORLEANS, LA 70115
(504) 897-5121
(504) 897-9743
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12877R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000204504201
UNITED HEALTHCARE
—
01
—
0401526
UNITED HEALTHCARE OF LA
LA
01
—
110220987
RAILROAD MEDICARE
—
05
—
1545759
—
LA
01
—
5255663
AETNA
—
Enumeration date
05/23/2005
Last updated
02/25/2016
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