Provider Demographics
NPI:1053458455
Name:WISDO FAMILY MEDICINE, JAMES JOHN WISDO DO PA
Entity Type:Organization
Organization Name:WISDO FAMILY MEDICINE, JAMES JOHN WISDO DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MEDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-622-9007
Mailing Address - Street 1:2685 SW 32ND PL STE 500
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7867
Mailing Address - Country:US
Mailing Address - Phone:352-622-9007
Mailing Address - Fax:352-622-2179
Practice Address - Street 1:2685 SW 32ND PL STE 500
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7867
Practice Address - Country:US
Practice Address - Phone:352-622-9007
Practice Address - Fax:352-622-2179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253125900Medicaid