Individual
GARY A WISCOMBE
Active
Individual
GARY A WISCOMBE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0225185-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02251854400001
BCBS
UT
01
—
107028132101
IHC
UT
01
—
22332
HEALTHY U
UT
01
—
72748
PEHP
UT
01
—
851248
DESERET MUTUAL
UT
01
—
QM0000076551
ALTIUS
UT
01
—
QMP0000033333378
MOLINA
UT
Enumeration date
09/16/2006
Last updated
07/08/2007
Update your record
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