Dr. Oliver Jayme Wisco
Dermatologist MOHS-Micrographic Surgeon
Dermatology Health Spcecialist 1693 Sw Chandler Ave Suite 250
Bend
, Oregon 97702-3231
Dr. Oliver Jayme Wisco
Dermatologist MOHS-Micrographic Surgeon
Dermatology Health Spcecialist 1693 Sw Chandler Ave Suite 250
Bend
, Oregon 97702-3231
(401) 443-4992
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Oliver Jayme Wisco
- 110 Elm St
- Providence, RI
- Zip : 02903-4626
- Phone : (401) 443-4992
Second Address
- Dr. Oliver Jayme Wisco
- Dermatology Health Spcecialist 1693 Sw Chandler Ave Suite 250
- Bend, OR
- Zip : 97702-3231
- Phone : (541) 382-8819
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207N00000X | Dermatologist | DOS-1007 | HI |
| N | 207ND0101X | MOHS-Micrographic Surgeon | 243103 | MA |
| Y | 207ND0101X | MOHS-Micrographic Surgeon | DO01032 | RI |
| N | 207ND0101X | MOHS-Micrographic Surgeon | DO157812 | OR |
National Provider Identifier
| NPI | 1164545166 |
|---|---|
| Provider Name | Dr. Oliver Jayme Wisco |
| First Address | Providence, RI 02903-4626 |
| Second Address | Bend, OR 97702-3231 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/04/2007 |
| Last Update Date | 11/08/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 12729019 | CAQH (01) | OR |
| 500674728 | (05) | OR |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.