Individual
JEFFREY J WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
52 W SHIRLEY AVE, WARRENTON, VA 20186
(540) 347-9220
(540) 347-0342
Mailing address
52 W SHIRLEY AVE, WARRENTON, VA 20186
(540) 347-9220
(540) 347-0342
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
101059130
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
328930
ANTHEM
VA
05
—
6407391
—
VA
Enumeration date
07/17/2006
Last updated
03/15/2011
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