Wiedemann, Jefferson Mark
Wiedemann, Jefferson Mark is an sole proprietor health care provider with primary practice located at 3800 Janes Rd , Arcata CA 95521-4742. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Wiedemann, Jefferson Mark can be contacted via phone (707) 822-3621.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | G82232 | California |
Profile Details
| NPI number | 1992741219 |
|---|---|
| LBN Legal business name | Wiedemann, Jefferson Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 22nd, 2006 |
| Last updated | Jun 18th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1992741219 | NPPES |
| California | MEDICAID | 00G822320 |
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