Provider Demographics
NPI:1831130814
Name:WIESEN, SCOTT L (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:WIESEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:625 9TH ST N
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-8143
Mailing Address - Country:US
Mailing Address - Phone:239-775-4444
Mailing Address - Fax:239-775-4445
Practice Address - Street 1:625 9TH ST N
Practice Address - Street 2:SUITE 304
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8143
Practice Address - Country:US
Practice Address - Phone:239-775-4444
Practice Address - Fax:239-775-4445
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0053124207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE64954Medicare UPIN