Healthcare Provider Details

I. General information

NPI: 1043573892
Provider Name (Legal Business Name): BRADLEY A WISLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 CYPRESS CREEK RD STE 202
CEDAR PARK TX
78613-4657
US

IV. Provider business mailing address

2000 S MAYS ST STE 201
ROUND ROCK TX
78664-7580
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-4272
  • Fax: 512-244-2895
Mailing address:
  • Phone: 512-492-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125061134
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number57404
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberQ9767
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberQ9767
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: