Provider Demographics
NPI:1114214384
Name:WISE, VANCE ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:VANCE
Middle Name:ERIC
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:SUITE MSB 2.130B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5389
Mailing Address - Country:US
Mailing Address - Phone:713-704-1478
Mailing Address - Fax:713-704-1715
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:SUITE MSB 2.130B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:713-704-1478
Practice Address - Fax:713-704-1715
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2016-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP200437902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology