Provider Demographics
NPI:1790883668
Name:WISE, BRIGHAM JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:BRIGHAM
Middle Name:JEFFREY
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1295 SAGE GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4848
Mailing Address - Country:US
Mailing Address - Phone:702-992-6888
Mailing Address - Fax:702-992-6880
Practice Address - Street 1:2410 FIRE MESA ST
Practice Address - Street 2:SUITE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9016
Practice Address - Country:US
Practice Address - Phone:702-992-6888
Practice Address - Fax:702-992-6880
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005026729207Q00000X
NV12313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine