Healthcare Provider Details

I. General information

NPI: 1821650391
Provider Name (Legal Business Name): SILAS WIEFELSPUETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 KLONDIKE RD
REPUBLIC WA
99166-9701
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7170
US

V. Phone/Fax

Practice location:
  • Phone: 509-775-3333
  • Fax:
Mailing address:
  • Phone: 928-336-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD61182905
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1908-R77732
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: