Provider Demographics
NPI:1770594251
Name:WISE, WILLIAM EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:WISE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 THOMAS LN
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1401
Mailing Address - Country:US
Mailing Address - Phone:614-566-4449
Mailing Address - Fax:614-533-0589
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:SUITE 4A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1401
Practice Address - Country:US
Practice Address - Phone:614-566-4449
Practice Address - Fax:614-533-0589
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-09-13
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Provider Licenses
StateLicense IDTaxonomies
OH52105208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773186Medicaid
OH0773186Medicaid
OHE76397Medicare UPIN