Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 036132577 | IL |
Y | 208800000X | Urologist | 154907 | AK |
NPI | 1053573147 |
---|---|
Provider Name | Herbert J Wiser |
First Address | Fairbanks, AK 99707-3720 |
Second Address | Springfield, IL 62702-3719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 26/06/2020 |