Provider Demographics
NPI:1093976045
Name:WIEKING, DANIEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:WIEKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:MSS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4207
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:537 SW UNION AVE., 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5788
Practice Address - Country:US
Practice Address - Phone:541-507-2050
Practice Address - Fax:541-507-2051
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD157235207XX0004X
ORMD157207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery