Healthcare Provider Details

I. General information

NPI: 1548826894
Provider Name (Legal Business Name): ERIC P WIESNER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E STAR CT STE A
MONTROSE CO
81401-6704
US

IV. Provider business mailing address

611 E STAR CT STE A
MONTROSE CO
81401-6704
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-4321
  • Fax: 970-249-2339
Mailing address:
  • Phone: 970-249-4321
  • Fax: 970-249-2339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC P WIESNER
Title or Position: PRESIDENT
Credential: MD
Phone: 608-692-9153