Individual
DR. BRUCE WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4105 KIRKMAN ST, LAKE CHARLES, LA 70607-4603
(337) 475-8022
Mailing address
278 HAMPTON CT, LAKE CHARLES, LA 70605-6586
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
10780R
LA
Other
Enumeration date
02/01/2007
Last updated
07/08/2007
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