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NPI Code Detail

MEDICARE: DUSTIN B. WISE, M.D., P.C.

MEDICARE: DUSTIN B. WISE, M.D., P.C.
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
1208000000XPediatrics Physician5247966-1205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932249299
Entity Type Code : Organization
Provider Name (Legal Business Name) : DUSTIN B. WISE, M.D., P.C.
Provider Business Mailing Address
First Line : 1888 W 800 N
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-4097
Country : US
Telephone Number : 801-492-7851
Fax Number : 801-492-7883
Provider Business Practice Location Address
First Line : 1888 W 800 N
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-4097
Country : US
Telephone Number : 801-492-7851
Fax Number : 801-492-7883
Authorized Official
Title or Position : OWNER
Name : DUSTIN B. WISE
Credential : M.D.
Telephone Number : 801-492-7851
Provider Enumeration Date : 02/07/2007
Last Update Date : 08/22/2020

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