Individual
DR. DEREK WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1937 W HARVARD AVE, ROSEBURG, OR 97471-2720
(541) 677-7200
(541) 229-3309
Mailing address
2570 NW EDENBOWER BLVD STE 100, ROSEBURG, OR 97471-6214
(541) 677-7200
(541) 229-3309
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD219665
OR
Other
Enumeration date
03/24/2021
Last updated
08/05/2024
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