Individual
JOHN WIEDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
16759 MAIN ST, STE 203, WILDWOOD, MO 63040-1232
(636) 458-4800
(636) 594-7500
Mailing address
16759 MAIN ST, SUITE 203, WILDWOOD, MO 63040-1232
(636) 458-4800
(636) 594-7500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R6G00
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000010043
ESSENCE
MS
01
—
0400320
UHC
MO
01
—
113996
HEALTHLINK
MO
01
—
127506
GHP
MO
01
—
16748
BCBS
MO
01
—
4104267
AETNA
MO
01
—
E10053
MERCY
MO
Enumeration date
11/18/2005
Last updated
05/02/2016
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