MEDICARE: MRS. SHARON L WIENER 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	208000000X	Pediatrics Physician	G8509	TX

General Provider Information

NPI Number	:	1972535383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON L WIENER MD

Provider Business Mailing Address
First Line	:	4301 N MACARTHUR BLVD STE 101
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6497
Country	:	US
Telephone Number	:	972-659-0404
Fax Number	:	972-659-0184

Provider Business Practice Location Address
First Line	:	4301 N MACARTHUR BLVD STE 101
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-6497
Country	:	US
Telephone Number	:	972-659-0404
Fax Number	:	972-659-0184

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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