MEDICARE: BRYAN WIECK MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J0361	TX

General Provider Information

NPI Number	:	1346517182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRYAN WIECK MD PA

Provider Business Mailing Address
First Line	:	1410 8TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3105
Country	:	US
Telephone Number	:	940-264-8818
Fax Number	:	940-264-8819

Provider Business Practice Location Address
First Line	:	1410 8TH ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-3105
Country	:	US
Telephone Number	:	940-264-8818
Fax Number	:	940-264-8819

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRYAN R WIECK
Credential	:	MD
Telephone Number	:	940-264-8818

Provider Enumeration Date	:	11/22/2011
Last Update Date	:	03/03/2025

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