Individual
DR. HARRY C WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 LAS TABLAS RD, TEMPLETON, CA 93465-9704
(805) 434-3500
Mailing address
PO BOX 605, TEMPLETON, CA 93465-0605
(805) 434-1375
(805) 434-1716
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G53163
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0065000
—
CA
01
—
ZZZ46801Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/20/2006
Last updated
07/08/2007
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