Basic Information
| Provider Information | |||||||||
| NPI: | 1972526754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIEDERMAN | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9071 E MISSISSIPPI AVE | ||||||||
| Address2: | SUITE 26G | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802472004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4697677044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 I-30 BOX | ||||||||
| Address2: | |||||||||
| City: | MESQUITE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751851672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726983300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | J5947 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | J5947 | 01 | TX | ALLOPATHIC PHYSICIAN LIC | OTHER |