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General NPI Number Information
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NPI Number | 1295602183
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Entity Type | Organization
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Legal Business Name | WISEMAN FAMILY PRACTICE CO PLLC
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1500 N GRANT ST # 5963
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City | DENVER
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State | CO
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Zip | 80203-1859
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Country | US
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Telephone | 512-345-8970
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Fax | 855-220-9655
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Provider Business Mailing Address
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Address Line | 2500 S LAKELINE BLVD STE 100
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City | CEDAR PARK
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State | TX
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Zip | 78613-2968
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Country | US
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Telephone | 512-345-8970
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Fax | 855-220-9655
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | JEREMY D WISEMAN
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Credential | MD
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Telephone | 512-345-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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