Provider Demographics
NPI:1174933923
Name:WIMER, ROBERT JR (MED)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:WIMER
Suffix:JR
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 E CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1116
Mailing Address - Country:US
Mailing Address - Phone:717-333-0844
Mailing Address - Fax:
Practice Address - Street 1:1312 E CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1116
Practice Address - Country:US
Practice Address - Phone:717-333-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000744103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst