Individual
DR. MATTHEW WIESINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 HARBOR BLVD, PORT CHARLOTTE, FL 33952-5000
(941) 766-4122
Mailing address
1555 SOQUEL DR, SANTA CRUZ, CA 95065-1705
(800) 817-1066
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A66549
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A665490
BLUE SHIELD
—
05
—
00A665490
—
CA
01
—
A66549
BLUE CROSS
—
Enumeration date
06/23/2006
Last updated
03/26/2021
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