Individual
JEFFREY ALAN WIEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2999 REGENT ST, #612, BERKELEY, CA 94705-2146
(510) 848-1727
(510) 848-8224
Mailing address
2999 REGENT ST, #612, BERKELEY, CA 94705-2146
(510) 848-1727
(510) 848-8224
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
A71035
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY49005Y
—
CA
Enumeration date
11/29/2006
Last updated
02/12/2008
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