Individual
BRIAN PATRICK WISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 N MARIO CAPECCHI DR RM 4S100, SALT LAKE CITY, UT 84112
(801) 581-2121
Mailing address
30 N MARIO CAPECCHI DR RM 4S100, SALT LAKE CITY, UT 84112
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
13908858-1205
UT
Other
Enumeration date
04/24/2019
Last updated
04/09/2024
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