MEDICARE: DORIS J WISE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	880	OK

General Provider Information

NPI Number	:	1871515130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS J WISE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 60847
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73146-0847
Country	:	US
Telephone Number	:	405-286-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 W MEMORIAL RD
Second Line	:	SUITE 7
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-7000
Country	:	US
Telephone Number	:	405-286-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/29/2019

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