Individual
ERIC R. WIEDOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7945 WOLF RIVER BLVD, GERMANTOWN, TN 38138-1733
(901) 683-0055
Mailing address
7714 POPLAR AVE STE 200, ATTN: CREDENTIALING, GERMANTOWN, TN 38138-3941
(901) 683-0055
(901) 922-6722
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
24301
MS
207RH0003X
Hematology & Oncology Physician
Primary
3015
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08484348
—
MS
05
—
Q022586
—
TN
Enumeration date
07/10/2010
Last updated
01/12/2021
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