Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 60945089 | WA |
N | 207PE0004X | Emergency Medical Services | 5101021512 | MI |
NPI | 1043602899 |
---|---|
Provider Name | Dr. Morgan M Wise |
First Address | Issaquah, WA 98029-6201 |
Second Address | Issaquah, WA 98029-6201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2015 |
Last Update Date | 30/06/2019 |