Provider Demographics
NPI:1033342720
Name:WISE, PERRY JOE (ND)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:JOE
Last Name:WISE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:HEALING HEART & HANDS
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0308
Mailing Address - Country:US
Mailing Address - Phone:360-581-2252
Mailing Address - Fax:
Practice Address - Street 1:723 BALLENTINE ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-3603
Practice Address - Country:US
Practice Address - Phone:360-581-2252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000808208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice