Provider Demographics
NPI:1689780090
Name:LAWRENCE J WIELAND MD
Entity Type:Organization
Organization Name:LAWRENCE J WIELAND MD
Other - Org Name:REDWOOD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-443-4593
Mailing Address - Street 1:2350 BUHNE ST STE A
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3205
Mailing Address - Country:US
Mailing Address - Phone:707-443-4593
Mailing Address - Fax:
Practice Address - Street 1:2350 BUHNE ST STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3205
Practice Address - Country:US
Practice Address - Phone:707-443-4593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077160Medicaid
CARHM03916FMedicaid
CARHM03916FMedicaid
CAZZZ36729ZMedicare PIN