Provider Demographics
NPI:1598951626
Name:WISE, NATALIE MYRNA (BACHIR) (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MYRNA (BACHIR)
Last Name:WISE
Suffix:
Gender:F
Credentials:MB BCH BAO
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:MYRNA
Other - Last Name:BACHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB BCH BAO
Mailing Address - Street 1:1601 TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1765
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 TRINITY ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1765
Practice Address - Country:US
Practice Address - Phone:512-324-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7674207RG0100X
MN53680207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology