Organization Name: | WIEMER FAMILY PODIATRY, LLC |
NPI Number: | 1063681260 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBBY JAMES WIEMER (OWNER) |
Mailing Address: | 850 W Chester Pike Suite 200 Havertown |
State: | PA US |
Postal Code: | 190834400 |
Phone Number: | 4844538164 |
Fax Number: | 4844538291 |
NPI Enumeration Date: | 02/21/2008 |
NPI Last Update Date: | 01/12/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0131X |
License Number: | SC004761L |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot Surgery |
Taxonomy Definition: |