Individual
JEREMY NYLE WIERSIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18802 MEISNER DR, SAN ANTONIO, TX 78258
(210) 572-2222
(210) 249-2177
Mailing address
PO BOX 1888, GREENVILLE, TX 75403
(800) 945-2455
(903) 453-2541
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H5500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136889611
—
TX
Enumeration date
05/03/2006
Last updated
03/12/2012
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