Provider Demographics
NPI:1508847294
Name:WIEMAN, JASON SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
Last Name:WIEMAN
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 1:2025 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-7487
Mailing Address - Country:US
Mailing Address - Phone:068-100-5858
Mailing Address - Fax:806-517-2667
Practice Address - Street 1:2025 MEMORY LN
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-7487
Practice Address - Country:US
Practice Address - Phone:806-810-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042972207Q00000X
TXK42942083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine