Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3328 | WV |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 18520 | WV |
NPI | 1154385185 |
---|---|
Provider Name | Dr. David Paul Wise |
First Address | Charleston, WV 25301-1953 |
Second Address | Charleston, WV 25301-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 18/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0047377000 | (05) | WV |
0047377-001 | (05) | WV |
850000198 | RAILROAD MEDICARE (01) | |
F95740 | (02) |