Provider Demographics
NPI:1053871004
Name:WISE, JEFFREY MARK II (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:WISE
Suffix:II
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 47159
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-0159
Mailing Address - Country:US
Mailing Address - Phone:763-559-3779
Mailing Address - Fax:763-450-3986
Practice Address - Street 1:14700 28TH AVE N STE 20
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4876
Practice Address - Country:US
Practice Address - Phone:763-559-3779
Practice Address - Fax:763-450-3986
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2023-02-08
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Provider Licenses
StateLicense IDTaxonomies
MN73128207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology