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General NPI Number Information
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NPI Number | 1336878784
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Entity Type | Individual
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Provider Name | WISMARD ALFRED
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Gender | Male
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 111 N ORANGE AVE STE 800
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City | ORLANDO
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State | FL
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Zip | 32801-2381
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Country | US
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Telephone | 140-792-9645
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N ORANGE AVE STE 800
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City | ORLANDO
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State | FL
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Zip | 32801-2381
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Country | US
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Telephone | 140-792-9645
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Fax |
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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 | 2278G1100X
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Taxonomy Name | General Care Certified Respiratory Therapist
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License Number | 9142
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License Number State | FL
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