Individual
CIARA LAUREN WISECUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3500 GASTON AVE, DALLAS, TX 75246-2088
(214) 820-2361
Mailing address
5761 LAWNDALE DR APT B, EL PASO, TX 79912-4256
(512) 213-5489
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
U6833
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2019
Last updated
08/07/2025
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