Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | DR.0036734 | CO |
N | 207RN0300X | Nephrologist | 36734 | CO |
NPI | 1033209713 |
---|---|
Provider Name | Alexander Clark Wiseman |
First Address | Denver, CO 80210-5850 |
Second Address | Denver, CO 80210-5850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76882781 | (05) | CO |