Individual
DR. GARY ROYCE WISNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
621 S HAM LN STE A, LODI, CA 95242-3533
(209) 368-7777
(209) 368-7778
Mailing address
621 S HAM LN STE A, LODI, CA 95242-3533
(209) 368-7777
(209) 368-7778
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A41236
CA
Other
Enumeration date
08/23/2006
Last updated
05/14/2008
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