Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 2015010246 | MO |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | Q8221 | TX |
NPI | 1184945297 |
---|---|
Provider Name | Dr. Kathryn Denise Wiesman |
First Address | Dallas, TX 75230-6825 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2010 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
362392802 | (05) | TX |