Provider Demographics
NPI:1548826894
Name:ERIC P WIESNER MD PLLC
Entity type:Organization
Organization Name:ERIC P WIESNER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIESNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-692-9153
Mailing Address - Street 1:611 E STAR CT STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6704
Mailing Address - Country:US
Mailing Address - Phone:970-249-4321
Mailing Address - Fax:970-249-2339
Practice Address - Street 1:611 E STAR CT STE A
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6704
Practice Address - Country:US
Practice Address - Phone:970-249-4321
Practice Address - Fax:970-249-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty