Healthcare Provider Details

I. General information

NPI: 1366542284
Provider Name (Legal Business Name): JOSE WILEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE FL 4
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

1430 TULANE AVE # 8648
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5263
  • Fax:
Mailing address:
  • Phone: 504-988-1001
  • Fax: 504-988-7795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number250025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number10083
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD.022996
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: