Provider Demographics
NPI:1407892748
Name:WIENER, JOHN SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SAMUEL
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:BOX 3831 DUKE UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-2121
Mailing Address - Country:US
Mailing Address - Phone:919-684-6994
Mailing Address - Fax:919-681-5507
Practice Address - Street 1:ERWIN ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-2121
Practice Address - Country:US
Practice Address - Phone:919-684-6994
Practice Address - Fax:919-681-5507
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33913208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891047FMedicaid
G51527Medicare UPIN
NC891047FMedicaid