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General NPI Number Information
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NPI Number | 1306987920
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Entity Type | Individual
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Provider Name | DAVID WISEMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 201 COX BLVD
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City | GOLDSBORO
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State | NC
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Zip | 27534-9479
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Country | US
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Telephone | 919-735-7580
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Fax | 919-580-9338
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Provider Business Mailing Address
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Address Line | 201 COX BLVD
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City | GOLDSBORO
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State | NC
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Zip | 27534-9479
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Country | US
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Telephone | 919-735-7580
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Fax | 919-580-9338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 102519
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License Number State | NC
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