Individual
RICHARD C WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 WINDWARD WAY, SUITE 101, KALISPELL, MT 59901-2619
(406) 752-8433
(406) 756-6768
Mailing address
430 WINDWARD WAY, SUITE 101, KALISPELL, MT 59901-2619
(406) 752-8433
(406) 756-6768
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4201
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11670
BLUE CROSS
MT
05
—
98107
—
MT
Enumeration date
05/19/2006
Last updated
01/05/2012
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