Provider Demographics
NPI:1790755684
Name:WISHMEYER, ROBERT JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:WISHMEYER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1801 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-5106
Mailing Address - Country:US
Mailing Address - Phone:601-679-2633
Mailing Address - Fax:601-679-3232
Practice Address - Street 1:1801 FULLER RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-5106
Practice Address - Country:US
Practice Address - Phone:601-679-2633
Practice Address - Fax:601-679-3232
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS1061148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant