Individual
DR. EDWARD LOUIS WIEBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8 W COLUMBUS AVE, FLAGSTAFF, AZ 86001-3202
(928) 774-4825
(928) 779-1008
Mailing address
8 W COLUMBUS AVE, FLAGSTAFF, AZ 86001-3202
(928) 226-7555
(928) 226-0014
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0076
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700270-001
—
AZ
01
—
AZ0065350
BC/BS ID#
AZ
Enumeration date
03/31/2006
Last updated
10/03/2011
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