Provider Demographics
NPI:1518162270
Name:WISNER, DOROTA JAKUBOWSKI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:JAKUBOWSKI
Last Name:WISNER
Suffix:
Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:BOX 0628
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0628
Mailing Address - Country:US
Mailing Address - Phone:415-443-5889
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:BOX 0628
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0628
Practice Address - Country:US
Practice Address - Phone:415-443-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA947252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology