Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 30264 | NE |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 64141 | AZ |
NPI | 1457710394 |
---|---|
Provider Name | Paul Wistermayer |
First Address | Scottsdale, AZ 85259-5452 |
Second Address | Scottsdale, AZ 85259-5452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2016 |
Last Update Date | 10/09/2021 |