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General NPI Number Information
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NPI Number | 1780627414
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Entity Type | Individual
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Provider Name | DAVID S. WISE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 11606 MILL ROCK RD
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2762
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Country | US
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Telephone | 210-258-5009
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Fax | 210-368-9440
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Provider Business Mailing Address
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Address Line | PO BOX 460625
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City | SAN ANTONIO
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State | TX
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Zip | 78246-0625
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Country | US
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Telephone | 210-258-5009
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Fax | 210-368-9440
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MDH8963
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | H8963
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License Number State | TX
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