THERON J WIESE

SALEM, OR
NPI1841648862
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: OR  PA184738)
Enumeration Date2016-05-31
Last Update Date2017-10-24
Business Address
THERON J WIESE PA-C
1395 COMMERCIAL ST SE
SALEM, OR 97302-4205
Phone number: 503-990-7187
Mailing Address
THERON J WIESE PA-C
6108 SW 18TH DR APT 9
PORTLAND, OR 97239-1951
Phone number: 971-344-9996
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