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General NPI Number Information
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NPI Number | 1386636843
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Entity Type | Individual
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Provider Name | RONALD E WISE MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 1435 WAZEE ST # 101
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City | DENVER
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State | CO
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Zip | 80202-1491
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Country | US
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Telephone | 303-299-9473
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Fax | 303-299-9472
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Provider Business Mailing Address
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Address Line | PO BOX 110429
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City | AURORA
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State | CO
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Zip | 80042-0429
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Country | US
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Telephone | 303-493-7000
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 34013
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number | 34013
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 34013
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License Number State | CO
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