Provider Demographics
NPI:1053314666
Name:WISSINGER, DANIEL H (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:WISSINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1203 RIDGEWAY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5316
Mailing Address - Country:US
Mailing Address - Phone:901-761-5544
Mailing Address - Fax:901-761-9088
Practice Address - Street 1:1203 RIDGEWAY RD
Practice Address - Street 2:STE 201
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5316
Practice Address - Country:US
Practice Address - Phone:901-761-5544
Practice Address - Fax:901-761-9088
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD20384207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0840400OtherUNITED HEALTCARE
MS0015301OtherMS MEDICAID
TN0103677OtherBLUE CROSS BLUE SHIELD
TN3050594Medicaid
0840400OtherUNITED HEALTCARE
TN3050594Medicaid