Doctor Name: | JOHN D WISE |
NPI Number: | 1346543345 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 5337740001 |
Business Practice Address: | 600 E Northside Dr Suite D Clinton, MS - 390563437 |
Business Phone Number: | 6019259473 |
Business Fax Number: | 6019259490 |
Mailing Address: | 600 E Northside Dr, Suite D CLINTON |
State: | MS |
Postal Code: | 390563437 |
Phone Number: | 6019259473 |
Fax Number: | 6019259490 |
NPI Enumeration Date: | 12/13/2010 |
NPI Last Update Date: | 01/04/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 5337740001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |