Healthcare Provider Details

I. General information

NPI: 1295602183
Provider Name (Legal Business Name): WISEMAN FAMILY PRACTICE CO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST # 5963
DENVER CO
80203-1859
US

IV. Provider business mailing address

2500 S LAKELINE BLVD STE 100
CEDAR PARK TX
78613-2968
US

V. Phone/Fax

Practice location:
  • Phone: 512-345-8970
  • Fax: 855-220-9655
Mailing address:
  • Phone: 512-345-8970
  • Fax: 855-220-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEREMY D WISEMAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 512-345-8970