Provider Demographics
NPI:1689679755
Name:WIER, DARYL D (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:D
Last Name:WIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ORANGE AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1026
Mailing Address - Country:US
Mailing Address - Phone:407-730-3627
Mailing Address - Fax:407-423-3817
Practice Address - Street 1:801 N ORANGE AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1026
Practice Address - Country:US
Practice Address - Phone:407-730-3627
Practice Address - Fax:407-423-3817
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL44599208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069587400Medicaid
FL15897XMedicare PIN
FL069587400Medicaid
FL15897WMedicare PIN
FL15897VMedicare PIN