Healthcare Provider Details

I. General information

NPI: 1710241567
Provider Name (Legal Business Name): JOHN CHRISTOPHER WUELLNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 MDG 5955 ZEAMER AVE
JBER AK
99506
US

IV. Provider business mailing address

673 MDG 5955 ZEAMER AVE
JBER AK
99506-1809
US

V. Phone/Fax

Practice location:
  • Phone: 75-801-5719
  • Fax:
Mailing address:
  • Phone: 907-580-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA147998
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: