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Individual

DR. DAVID S. WISE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
11606 MILL ROCK RD, SAN ANTONIO, TX 78230-2762
(210) 258-5009
(210) 368-9440
Mailing address
PO BOX 460625, SAN ANTONIO, TX 78246-0625
(210) 258-5009
(210) 368-9440

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MDH8963
TX
207RC0001X
Clinical Cardiac Electrophysiology Physician
H8963
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0063CN
BLUE CROSS ID NUMBER
TX
01
060050641
RAILROAD MEDICARE NUMBER
TX
05
113351401
TX
Enumeration date
06/13/2006
Last updated
11/29/2016
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