Tully Wiedman, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

C35371 Issued in CA

Practice address

5724 Silveyville Road
Dixon, CA 95620

Phone

(707) 689-6522

NPI assigned

Feb 8, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Chase Dennis Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Santa Rosa, CA
  • NPI 1033152350
  NPD (past)
• Emergency Physicians Medical Group, Inc

  • Emergency Medicine Physician
  • Rancho Mirage, CA
  • NPI 1154362549
  NPD (past)
• Solano Gateway Medical Group Inc

  • Emergency Medicine Physician
  • Fairfield, CA
  • NPI 1952344293
  NPD (past)
• Southern Solano Emergency Medical Group, Inc

  • Emergency Medicine Physician
  • Vallejo, CA
  • NPI 1629006655
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256083200000",
    "number": "1285774182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "DIXON",
            "state": "CA",
            "postal_code": "956200369",
            "telephone_number": "707-689-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5724 SILVEYVILLE ROAD",
            "city": "DIXON",
            "state": "CA",
            "postal_code": "95620",
            "telephone_number": "707-689-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEDMAN",
        "first_name": "TULLY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2009-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "C35371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C353710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lily Villa
• Robert Edward Wagner, PHD
• Wal-Mart Stores, Inc. (Vision Center 30-5139)
• Walmart Inc. (Walmart Pharmacy 10-5139)
• Clark Lyle Webb, LMFT
• Kristina Linde Wiley, D.D.S.
• David Alan Wilkins, D.M.D.
• Kim Willard
• Christopher Choy Won
• Leah Wondrak, SLP

• Emergency Medicine Physician in Dixon, CA
• Providers in Dixon, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.