| Alphaeus Wise, MD | |
|
1150 Civic Dr Suite 100 Walnut Creek CA 94596-8241 | |
| (925) 935-3113 | |
| (925) 935-4482 |
| Full Name | Alphaeus Wise, MD |
|---|---|
| Speciality | Family Medicine |
| Location | 1150 Civic Dr, Walnut Creek, California |
| Authorized Official Name and Position | Alphaeus Mansfield Wise (PRESIDENT) |
| Authorized Official Contact | 9259353113 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alphaeus Wise, MD 1150 Civic Dr Suite 100 Walnut Creek CA 94596-8241 Ph: (925) 935-3113 | Alphaeus Wise, MD 1150 Civic Dr Suite 100 Walnut Creek CA 94596-8241 Ph: (925) 935-3113 |
| NPI Number | 1811917693 |
|---|---|
| Provider Enumeration Date | 07/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7810990017 |
|---|---|
| Medicare Enrollment ID | O20060808000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811917693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A95309 (California) | Primary |
| Provider Name | Alphaeus M Wise |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265475628 PECOS PAC ID: 7517918808 Enrollment ID: I20061006000585 |
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