MEDICARE: MR. ROBERT JAMES WISHMEYER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1061148	MS

General Provider Information

NPI Number	:	1790755684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT JAMES WISHMEYER PA-C

Provider Business Mailing Address
First Line	:	1801 FULLER RD
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39309-5106
Country	:	US
Telephone Number	:	601-679-2633
Fax Number	:	601-679-3232

Provider Business Practice Location Address
First Line	:	1801 FULLER RD
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39309-5106
Country	:	US
Telephone Number	:	601-679-2633
Fax Number	:	601-679-3232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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