Provider Demographics
NPI:1487661724
Name:WISHNEW, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:WISHNEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6633 E HWY 290
Mailing Address - Street 2:STE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1172
Mailing Address - Country:US
Mailing Address - Phone:512-314-3834
Mailing Address - Fax:512-314-7121
Practice Address - Street 1:6633 E HWY 290
Practice Address - Street 2:STE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1172
Practice Address - Country:US
Practice Address - Phone:512-314-3834
Practice Address - Fax:512-314-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2009-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXG7380208200000X, 2082S0105X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000FS557Medicaid
OFS55Medicare PIN
TXP000FS557Medicaid