Wiese, Jon D

Wiese, Jon D is an individual health care provider with primary practice located at 521 W State Road 434 Suite 301, Longwood FL 32750-5166. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Wiese, Jon D can be contacted via phone (407) 767-5808.

Contact Information

Primary practice address
521 W State Road 434 Suite 301 Longwood FL 32750-5166
Phone: (407) 767-5808
Fax: (407) 767-5892
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X ME54060 Florida

Profile Details

NPI number 1952474561
LBN Legal business name Wiese, Jon D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 15th, 2006
Last updated Nov 14th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952474561 NPPES
Florida Other ME54060 MEDICAL LICENSE
Florida MEDICAID 049597200 MEDICAL LICENSE

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