Individual
PAUL D WIESNER
Active
Individual
PAUL D WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
25545
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01255454
—
CO
01
—
0754950001
DME REGION C PALMETTO GBA
—
01
—
180002594
RAILROAD MEDICARE
—
01
—
45289
BLUECROSS BLUE SHIELD
—
01
—
840851676003
ROCKY MOUNTAIN HEALTH PLA
—
Enumeration date
01/18/2007
Last updated
02/23/2021
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