Tully Wiedman, MD is a
Emergency Medicine physician based in Dixon, California. Tully Wiedman is licensed to practice in California (license number C35371) and his current practice location is 5724 Silveyville Road, Dixon, California. He can be reached at his office (for appointments etc.) via phone at
(707) 689-6522.
NPI number for Tully Wiedman is 1285774182 and his current mailing address is Po Box 369, Dixon, California. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1285774182.
Physician's Profile
| Full Name | Tully Wiedman |
|---|
| Gender | Male |
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| Speciality | Emergency Medicine |
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| Location | 5724 Silveyville Road, Dixon, California |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1285774182
- Provider Enumeration Date: 02/08/2007
- Last Update Date: 10/21/2009
Medical Identifiers
Medical identifiers for Tully Wiedman such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1285774182 | NPI | - | NPPES |
| 00C353710 | Medicaid | CA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207P00000X | Emergency Medicine | C35371 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Tully Wiedman is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Tully Wiedman, MD
Po Box 369,
Dixon, CA 95620-0369
Ph: (707) 689-6522 | Tully Wiedman, MD
5724 Silveyville Road,
Dixon, CA 95620
Ph: (707) 689-6522 |
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