Provider Demographics
NPI:1639317274
Name:WIEMER, ROBERT A JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:WIEMER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:528-F KLONDIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560
Mailing Address - Country:US
Mailing Address - Phone:228-304-2906
Mailing Address - Fax:228-575-5088
Practice Address - Street 1:528-F KLONDIKE ROAD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560
Practice Address - Country:US
Practice Address - Phone:228-304-2906
Practice Address - Fax:228-575-5088
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2014-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA346812081N0008X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine