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General NPI Number Information
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NPI Number | 1316258791
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Entity Type | Organization
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Legal Business Name | W. ROBERT WISMAN MD PC
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 1506 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24016-5207
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Country | US
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Telephone | 540-345-8124
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Fax | 540-345-3423
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Provider Business Mailing Address
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Address Line | 1506 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24016-5207
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Country | US
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Telephone | 540-345-8124
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Fax | 540-345-3423
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. W ROBERT WISMAN
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Credential | MD
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Telephone | 540-345-8124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0101014128
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License Number State | VA
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