Provider Demographics
NPI:1497872212
Name:TIMOTHY M. WIEBE
Entity Type:Organization
Organization Name:TIMOTHY M. WIEBE
Other - Org Name:TIMOTHY M. WIEBE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:WIEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-264-9009
Mailing Address - Street 1:103 ALDERSGATE CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1301
Mailing Address - Country:US
Mailing Address - Phone:601-264-9009
Mailing Address - Fax:601-264-9012
Practice Address - Street 1:103 ALDERSGATE CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1301
Practice Address - Country:US
Practice Address - Phone:601-264-9009
Practice Address - Fax:601-264-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-25
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15590207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty