Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD 010397 | TN |
NPI | 1003922881 |
---|---|
Provider Name | Dr. H James Wiesman JR. |
First Address | Columbia, TN 38401 |
Second Address | Columbia, TN 38401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 20/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D70218 | (02) |