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General NPI Number Information
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NPI Number | 1629272901
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Entity Type | Individual
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Provider Name | JANE WISEMAN STRADER MD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1109 BELLEFONTE RD
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City | FLATWOODS
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State | KY
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Zip | 41139-2503
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Country | US
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Telephone | 606-836-8086
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Fax | 606-836-3743
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Provider Business Mailing Address
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Address Line | PO BOX 1595
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City | ASHLAND
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State | KY
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Zip | 41105-1595
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Country | US
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Telephone | 606-408-4000
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35096112
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 43728
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License Number State | KY
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