Provider Demographics
NPI:1508847294
Name:WIEMAN, JASON SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:WIEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2104 GRIZZLY TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5656
Mailing Address - Country:US
Mailing Address - Phone:254-702-0618
Mailing Address - Fax:254-287-9437
Practice Address - Street 1:1ST CAVALRY DIVISION HQ
Practice Address - Street 2:DIVISION SURGEON SECTION
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-9392
Practice Address - Fax:254-287-9437
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA042972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine