Individual
JOEL WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 680, FORT WORTH, TX 76104
(817) 250-4235
(817) 885-7701
Mailing address
1325 PENNSYLVANIA AVE STE 680, FORT WORTH, TX 76104-2133
(817) 250-4235
(817) 885-7701
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA12151
TX
Other
Enumeration date
06/04/2018
Last updated
08/02/2018
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