Individual
BRETT W WIESLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 E 3900 S, SALT LAKE CITY, UT 84124-1300
(801) 268-7975
Mailing address
1520 ROOSEVELT AVE, SALT LAKE CITY, UT 84105-2731
(801) 906-8218
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2345271
NY
207P00000X
Emergency Medicine Physician
Primary
6108579-2105
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
870306646002
—
UT
Enumeration date
06/09/2006
Last updated
07/09/2007
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