Provider Demographics
NPI:1447079249
Name:WIERSMA, STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:WIERSMA
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:UNIT 2310 BOX 99
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AE
Mailing Address - Zip Code:09816-0099
Mailing Address - Country:US
Mailing Address - Phone:858-220-2898
Mailing Address - Fax:
Practice Address - Street 1:UNIT 2310 BOX 99
Practice Address - Street 2:
Practice Address - City:DPO
Practice Address - State:AE
Practice Address - Zip Code:09816-0099
Practice Address - Country:US
Practice Address - Phone:858-220-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME745692083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine