NATHANIEL RICHARD WISE MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036161948

License Status

NOT RENEWED

Business

Title

First Name

NATHANIEL

Middle

RICHARD

Last Name

WISE

Business Name

NATHANIEL RICHARD WISE MD

Original Issue Date

08/12/2022

Effective Date

08/12/2022

Expiration Date

07/31/2023

City

TEXARKANA

State

Zip

75501

Ever Disciplined

LastModifiedDate

11/30/2023