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NPI Code Detail

MEDICARE: DALE RAY WIETHOLTER MD

MEDICARE: DALE RAY WIETHOLTER MD
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
1207P00000XEmergency Medicine PhysicianME25941FL

General Provider Information

NPI Number : 1407928369
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALE RAY WIETHOLTER MD
Provider Business Mailing Address
First Line : 8782 ESTATE DR
Second Line :
City : ROYAL PALM BEACH
State : FL
Zip : 33411-6592
Country : US
Telephone Number : 561-791-0376
Fax Number :
Provider Business Practice Location Address
First Line : 2007 PALM BEACH LAKES BLVD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33409-6501
Country : US
Telephone Number : 561-420-8555
Fax Number : 888-442-6078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2006
Last Update Date : 04/08/2015

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Directions to “ DALE RAY WIETHOLTER MD” Practice Location

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