Provider Demographics
NPI:1508837998
Name:WISDO, JAMES JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOHN
Last Name:WISDO
Suffix:
Gender:M
Credentials:DO
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 830910
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34483
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253125900Medicaid
FLP00171886OtherRR MEDICARE
FL57560OtherBCBS
FLP00171886OtherRR MEDICARE
FL57560UMedicare ID - Type Unspecified