MEDICARE: DR. JOHN MORITZ WIEMANN IV 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	207XP3100X	Pediatric Orthopaedic Surgery Physician	A140151	CA
2	207X00000X	Orthopaedic Surgery Physician	A140151	CA

General Provider Information

NPI Number	:	1730228768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MORITZ WIEMANN IV MD

Provider Business Mailing Address
First Line	:	2625 E DIVISADERO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 E ROYAL DORNOCH AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93730-5140
Country	:	US
Telephone Number	:	937-641-9594
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	03/11/2024

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