Provider Demographics
NPI:1912092768
Name:WISE, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:WISE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7150 W SUNSET RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:7200 CATHEDRAL ROCK DR.
Practice Address - Street 2:SUITE 180
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0466
Practice Address - Country:US
Practice Address - Phone:702-341-9000
Practice Address - Fax:702-341-5864
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-12-01
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Provider Licenses
StateLicense IDTaxonomies
NV5572208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1912092768Medicaid
NV100471Medicare PIN
NV1912092768Medicaid