Individual
ETHAN RON WIESLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-8018
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-8018
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
9600222
NC
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
96-00222
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126FF
BCBS
—
05
—
1850002000
—
WV
01
—
200043944
RR MEDICARE
—
01
—
2280373A
MEDCIARE
NC
01
—
36195
PARTNERS
—
05
—
6402941
—
VA
01
—
7122310
AETNA
—
05
—
89126FF
—
NC
01
—
98579
MEDCOST
—
Enumeration date
12/23/2005
Last updated
08/20/2020
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