Individual
TODD V WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1321 NE 99TH AVE STE 100, PORTLAND, OR 97220-9437
(503) 893-6670
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD21898
OR
207R00000X
Internal Medicine Physician
MD60003713
WA
207R00000X
Internal Medicine Physician
S8264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287272
—
OR
Enumeration date
04/20/2006
Last updated
04/02/2024
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