Provider Demographics
NPI:1851504682
Name:WISENER, ROBERT HENRY III (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:WISENER
Suffix:III
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 N TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-9780
Mailing Address - Country:US
Mailing Address - Phone:956-584-3767
Mailing Address - Fax:956-584-3767
Practice Address - Street 1:4309 N 10TH ST
Practice Address - Street 2:SUITE F 5
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3057
Practice Address - Country:US
Practice Address - Phone:956-687-2202
Practice Address - Fax:956-584-3767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21581103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical