Individual
DR. PAUL EDWARD WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 FOREST PARK AVE, DIV SURG COLON/RECTAL, 5TH FL, SAINT LOUIS, MO 63108-2114
(314) 454-7177
(888) 425-7946
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 454-7177
(888) 425-7946
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2012011934
MO
208C00000X
Colon & Rectal Surgery Physician
Primary
2012011934
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209625003
—
MO
Enumeration date
09/22/2006
Last updated
04/17/2025
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