Individual
DR. THOMAS R WIETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3070 N HIGHWAY 17, SUITE 202, MOUNT PLEASANT, SC 29466-9300
(843) 881-8346
(843) 284-4093
Mailing address
3070 N HIGHWAY 17, SUITE 202, MOUNT PLEASANT, SC 29466-9300
(843) 881-8346
(843) 284-4093
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
10486
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518149350
NPI
SC
Enumeration date
06/27/2006
Last updated
02/05/2008
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