Organization
JON D WIESE MD FACS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON D. WIESE M.D. (PRESIDENT)
(407) 332-1995
Entity
Organization
Contact information
Practice address
521 W STATE ROAD 434, SUITE 305, LONGWOOD, FL 32750-4984
(407) 332-1995
(407) 332-1404
Mailing address
521 W STATE ROAD 434, SUITE 305, LONGWOOD, FL 32750-4984
(407) 332-1995
(407) 332-1404
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME54060
FL
Other
Enumeration date
03/24/2008
Last updated
04/03/2008
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