Healthcare Provider Details

I. General information

NPI: 1306374210
Provider Name (Legal Business Name): ROBERT J WISSNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W MARKET ST STE 200
AKRON OH
44313-4234
US

IV. Provider business mailing address

1100 22ND ST SE
SALEM OR
97302-6558
US

V. Phone/Fax

Practice location:
  • Phone: 800-941-6672
  • Fax:
Mailing address:
  • Phone: 503-967-6771
  • Fax: 503-385-8421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberDO214552
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO214552
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number34.013559
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: