Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 139864 | FL |
Y | 208000000X | Pediatrician | 139864 | FL |
NPI | 1790136927 |
---|---|
Provider Name | Robert Wiser |
First Address | Mount Dora, FL 32757-7863 |
Second Address | Orlando, FL 32806-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2016 |
Last Update Date | 12/05/2021 |