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General NPI Number Information
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NPI Number | 1710793419
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Entity Type | Individual
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Provider Name | BRADLEY WIELAND PA
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Gender | Male
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 345 N GRANT ST
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City | CANBY
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State | OR
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Zip | 97013-3610
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Country | US
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Telephone | 503-266-2066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1648
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City | EUGENE
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State | OR
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Zip | 97440-1648
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Country | US
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Telephone | 541-687-4905
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA227388
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License Number State | OR
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