Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A140151 | CA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | A140151 | CA |
NPI | 1730228768 |
---|---|
Provider Name | John Moritz Wiemann IV |
First Address | Fresno, CA 93721-1431 |
Second Address | Clovis, CA 93611-9205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 04/11/2019 |