Individual
JEROME WIEDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12605 E 16TH AVE, AURORA, CO 80045-2545
(720) 848-0000
Mailing address
PO BOX 110429, AURORA, CO 80042-0429
(303) 493-7000
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
15797
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01157973
—
CO
Enumeration date
10/09/2006
Last updated
09/17/2012
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