Provider Demographics
NPI:1508945593
Name:WISE, WILLIAM E JR (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:WISE
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2460 N IH 35 E STE 100
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5267
Mailing Address - Country:US
Mailing Address - Phone:469-800-9500
Mailing Address - Fax:469-800-9505
Practice Address - Street 1:2460 N IH 35 E STE 100
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5267
Practice Address - Country:US
Practice Address - Phone:469-800-9500
Practice Address - Fax:303-302-0808
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO50666207R00000X
AZ4353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151086Medicaid
AZ151086Medicaid