Healthcare Provider Details

I. General information

NPI: 1548266232
Provider Name (Legal Business Name): JOSEPH WYSOKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9969 FREDERICKSBURG RD
SAN ANTONIO TX
78240-4106
US

IV. Provider business mailing address

9969 FREDERICKSBURG RD
SAN ANTONIO TX
78240-4106
US

V. Phone/Fax

Practice location:
  • Phone: 210-690-2273
  • Fax: 210-581-8209
Mailing address:
  • Phone: 210-690-2273
  • Fax: 210-581-8209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG8520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: