Provider Demographics
NPI:1679979249
Name:WIEGAND, DAVID (OP/L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:WIEGAND
Suffix:
Gender:M
Credentials:OP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 SADDLE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1905
Mailing Address - Country:US
Mailing Address - Phone:615-891-0104
Mailing Address - Fax:
Practice Address - Street 1:501 SADDLE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1905
Practice Address - Country:US
Practice Address - Phone:615-891-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT045222Z00000X
TNPRO034224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist