Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 26999 | OK |
Y | 207SG0201X | Clinical Genetics (M.D.) | ME137139 | FL |
NPI | 1548363724 |
---|---|
Provider Name | Dr. Klaas J Wierenga |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 28/08/2020 |