Individual
MR. ROBERT EUGENE WISE
Active
Individual
MR. ROBERT EUGENE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
5586107-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86924214
—
NM
01
—
P00469890
RR MEDICARE
NM
Enumeration date
03/08/2007
Last updated
07/30/2008
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