Provider Demographics
NPI:1720212954
Name:WIEKHORST, WAYNE (DVM)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:WIEKHORST
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48410 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6911
Mailing Address - Country:US
Mailing Address - Phone:623-465-9488
Mailing Address - Fax:623-465-5922
Practice Address - Street 1:48410 N BLACK CANYON HWY
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6911
Practice Address - Country:US
Practice Address - Phone:623-465-9488
Practice Address - Fax:623-465-5922
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ970174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian