Provider Demographics
NPI:1497740518
Name:WIESER, ERIC S (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:WIESER
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:PO BOX 120489
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-0489
Mailing Address - Country:US
Mailing Address - Phone:817-375-5200
Mailing Address - Fax:817-299-1708
Practice Address - Street 1:800 ORTHOPEDIC WAY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-1629
Practice Address - Country:US
Practice Address - Phone:817-375-5200
Practice Address - Fax:817-299-1708
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8558207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165198601Medicaid
TX165198601Medicaid
I00037Medicare UPIN