Doctor Name: | DAVID WISEMAN |
NPI Number: | 1306987920 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 102519 |
Business Practice Address: | 201 Cox Blvd Goldsboro, NC - 275349479 |
Business Phone Number: | 9197357580 |
Business Fax Number: | 9195809338 |
Mailing Address: | 201 Cox Blvd, GOLDSBORO |
State: | NC |
Postal Code: | 275349479 |
Phone Number: | 9197357580 |
Fax Number: | 9195809338 |
NPI Enumeration Date: | 02/08/2007 |
NPI Last Update Date: | 08/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 102519 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |