Provider Demographics
NPI:1780667345
Name:WIEDEMAN, JAMES ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ERIC
Last Name:WIEDEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:419 HERON PL
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-7512
Mailing Address - Country:US
Mailing Address - Phone:530-759-0726
Mailing Address - Fax:916-366-5482
Practice Address - Street 1:10535 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:CA
Practice Address - Zip Code:95655-4200
Practice Address - Country:US
Practice Address - Phone:916-843-7222
Practice Address - Fax:916-366-5475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77763208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery