Healthcare Provider Details

I. General information

NPI: 1508797721
Provider Name (Legal Business Name): BERNARD WIREDU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

IV. Provider business mailing address

20251 TARPON BAY LN
CYPRESS TX
77433-5177
US

V. Phone/Fax

Practice location:
  • Phone: 956-310-2735
  • Fax:
Mailing address:
  • Phone: 956-310-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberRTL260724
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: