Provider Demographics
NPI:1386626208
Name:WISNER, DAVID HAMILTON (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HAMILTON
Last Name:WISNER
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 1:2315 STOCKTON BLVD
Mailing Address - Street 2:ROOM 3111 CYPRESS BLDG.
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-8298
Mailing Address - Fax:916-734-5119
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:ROOM 3111 CYPRESS BLDG.
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-8298
Practice Address - Fax:916-734-5119
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG487422086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery