Gordon G Wisbach III, M.D

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A75212 Issued in CA

Practice address

34800 Bob Wilson Drive
Nmcsd
San Diego, CA 92134

Phone

(619) 532-7579

NPI assigned

Jun 12, 2006

Last updated

Oct 21, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413849600000",
    "number": "1528000783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4442 VEREDA LUNA LLENA",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302666",
            "telephone_number": "619-823-9678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DRIVE",
            "address_2": "NMCSD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92134",
            "telephone_number": "619-532-7579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISBACH",
        "first_name": "GORDON",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A75212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Wintz, MD
• Jamie Leigh Wion, RADT
• Tyler Wipf
• Jan Wirsching, RD
• Elyjah Wirth
• Briana Wischnack, NP
• Shelley Wisdom-Lazar, LCSW
• Wise Counsel Psychology Inc
• Wise Mind Behavioral Therapy, PLLC (Wise Mind Behavioral Therapy)
• Wise Self Psychology, Inc.

• Surgery Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.