Healthcare Provider Details

I. General information

NPI: 1790136927
Provider Name (Legal Business Name): ROBERT WISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

21624 SULLIVAN RANCH BLVD
MOUNT DORA FL
32757-7863
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6876
  • Fax: 407-872-0544
Mailing address:
  • Phone: 931-993-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number139864
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN23581
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number139864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: