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Individual

DR. GORDON G WISBACH III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
34800 BOB WILSON DRIVE, NMCSD, SAN DIEGO, CA 92134
(619) 532-7579
Mailing address
4442 VEREDA LUNA LLENA, SAN DIEGO, CA 92130-2666
(619) 823-9678

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A75212
CA

Other

Enumeration date
06/12/2006
Last updated
10/21/2014
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