Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 61811 | AZ |
NPI | 1033404959 |
---|---|
Provider Name | Dr. Jason T. Wiseman |
First Address | Phoenix, AZ 85004-2155 |
Second Address | Phoenix, AZ 85004-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2011 |
Last Update Date | 09/03/2021 |