Organization
JOHN D WISE III
Active
Other names
Comfortwise Footwear
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN DURR WISE III C. PED. (PRINCIPAL)
(601) 925-9473
Entity
Organization
Contact information
Practice address
600 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3437
(601) 925-9473
(601) 925-9490
Mailing address
600 E NORTHSIDE DR, SUITE D, CLINTON, MS 39056-3437
(601) 925-9473
(601) 925-9490
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02053764
—
MS
Enumeration date
07/12/2006
Last updated
11/09/2010
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