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General NPI Number Information
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NPI Number | 1497872212
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Entity Type | Organization
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Legal Business Name | TIMOTHY M. WIEBE
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Dates
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Enumeration Date | 03/25/2007
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 103 ALDERSGATE CIR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1301
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Country | US
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Telephone | 601-264-9009
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Fax | 601-264-9012
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Provider Business Mailing Address
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Address Line | 103 ALDERSGATE CIR
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City | HATTIESBURG
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State | MS
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Zip | 39402-1301
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Country | US
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Telephone | 601-264-9009
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Fax | 601-264-9012
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY MITCHELL WIEBE
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Credential | M.D.
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Telephone | 601-264-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 15590
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License Number State | MS
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