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General NPI Number Information
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NPI Number | 1063306371
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Entity Type | Individual
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Provider Name | MATTHEW DAVID WIEFELS MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 800 STANTON L YOUNG BLVD # 1464
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5018
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Country | US
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Telephone | 405-271-5504
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Fax |
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Provider Business Mailing Address
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Address Line | 1916 HERITAGE PARK DR APT 148
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-7547
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Country | US
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Telephone | 305-992-8522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 45936
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License Number State | OK
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