Individual provider · Type 1 NPI

Theron J. Wiese, PA-C

Medical Physician Assistant · Salem, OR

NPI number 1841648862 Active

Practice location

1395 Commercial St SE
Salem, OR 97302-4205

Call (503) 990-7187 Map

Mailing address

6108 SW 18th Dr Apt 9
Portland, OR 97239-1951

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA184738 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1841648862

Theron J. Wiese, PA-C's National Provider Identifier is 1841648862, issued on May 31, 2016. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Salem, OR. The record was last updated on Oct 24, 2017.