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Individual

MICHAEL ROGER WIEDMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
731 LEIGHTON AVE, SUITE 300, ANNISTON, AL 36207-5761
(256) 236-4121
(256) 237-5254
Mailing address
PO BOX 1765, ANNISTON, AL 36202-1765
(256) 236-4121
(256) 237-5254

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD.23204
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000094128
AL
01
051094128
BLUE SHIELD
AL
Enumeration date
10/18/2005
Last updated
06/13/2023
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