Active NPI
William Rex Wiseman, DO
- Anatomic Pathology & Clinical Pathology Physician
- Rockledge, FL
National Provider Identifier
1417282997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- OS15712
- Practice address
- 110 Longwood Ave
Rockledge, FL 32955-2828 - Phone
- (321) 636-2211
- NPI assigned
- Oct 16, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 5101018518 | MI | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | OS15712 | FL | Primary |
Addresses
Primary practice location
110 Longwood Ave
Rockledge, FL 32955-2828
Mailing address
1500 E Medical Center Dr
Ann Arbor, MI 48109-5000
Phone (734) 764-3270
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101514800 | Medicaid | FL | |
| KN896 | Other | FL | MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101018518 | MI | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1417282997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 E MEDICAL CENTER DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481095000",
"telephone_number": "734-764-3270",
"fax_number": "734-936-7361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 LONGWOOD AVE",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329552828",
"telephone_number": "321-636-2211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISEMAN",
"first_name": "WILLIAM",
"middle_name": "REX",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-10-16",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MI",
"license": "5101018518",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "FL",
"license": "OS15712",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "101514800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "KN896",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockledge, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.