Provider Demographics
NPI:1033209713
Name:WISEMAN, ALEXANDER CLARK (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CLARK
Last Name:WISEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 S DOWNING ST STE 380
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5850
Mailing Address - Country:US
Mailing Address - Phone:303-778-5797
Mailing Address - Fax:303-778-5205
Practice Address - Street 1:2535 S DOWNING ST STE 380
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5850
Practice Address - Country:US
Practice Address - Phone:303-778-5797
Practice Address - Fax:303-778-5205
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36734207RN0300X
CODR.0036734204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76882781Medicaid
COF72745Medicare PIN