MEDICARE: DR. CLIFFORD FRANK WIEGAND 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
1	207R00000X	Internal Medicine Physician	MD18429	TN
2	207RN0300X	Nephrology Physician	MD18429	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588669170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD FRANK WIEGAND MD

Provider Business Mailing Address
First Line	:	107 WOODLAWN DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5978
Country	:	US
Telephone Number	:	423-929-7158
Fax Number	:	423-828-9625

Provider Business Practice Location Address
First Line	:	107 WOODLAWN DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5978
Country	:	US
Telephone Number	:	423-929-7158
Fax Number	:	423-828-9625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	12/28/2009

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