Provider Demographics
NPI:1558326876
Name:WISSINGER, JOHN FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:WISSINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2100 REGIONAL MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-9719
Mailing Address - Country:US
Mailing Address - Phone:979-532-1700
Mailing Address - Fax:979-532-4584
Practice Address - Street 1:1602 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-2640
Practice Address - Country:US
Practice Address - Phone:979-543-2956
Practice Address - Fax:979-543-6756
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00403974OtherRAILROAD GBA - RAILROAD MEDICARE
TXP01090558OtherRAILROAD MEDICARE PTAN
TX119167803Medicaid
TX119167804Medicaid
TX887914OtherBC/BS TX#
TX8DE552OtherBC/BS #
TXTXB150989Medicare PIN
TXB27633Medicare UPIN
TX119167803Medicaid