Provider Demographics
NPI:1598080228
Name:WIEBEL, JAIME LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:LAUREN
Last Name:WIEBEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LAUREN
Other - Last Name:LEGENDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10260 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 100 N
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3437
Mailing Address - Country:US
Mailing Address - Phone:214-363-5535
Mailing Address - Fax:
Practice Address - Street 1:10260 N CENTRAL EXPY
Practice Address - Street 2:SUITE 100 N
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3437
Practice Address - Country:US
Practice Address - Phone:214-363-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096871207R00000X
TXQ3615207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine