Individual
MATTHEW KEITH WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
NAU CAMPUS HEALTH SERVICES, 824 SOUTH SAN FRANCISCO ST, FLAGSTAFF, AZ 86001
(928) 523-2131
(928) 527-4327
Mailing address
PO BOX 6033, FLAGSTAFF, AZ 86011
(928) 523-2131
(928) 527-4327
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45216
AZ
207Q00000X
Family Medicine Physician
AA4327
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
840513
—
AZ
05
—
MD8586
—
AK
Enumeration date
06/14/2006
Last updated
06/30/2023
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