Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101249076 | VA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0070654 | MD |
NPI | 1316128275 |
---|---|
Provider Name | Dr. Jacob Michael Wisbeck |
First Address | Baltimore, MD 21218-2867 |
Second Address | Baltimore, MD 21218-2867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 03/06/2014 |