Individual
MR. ROBERT R WISNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
269 PORTLAND WAY S, GALION, OH 44833-2312
(419) 462-4560
(419) 462-4566
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
(419) 468-0522
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50001338
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0083696
—
OH
01
—
H375510
MEDICARE
OH
Enumeration date
01/23/2006
Last updated
11/18/2020
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