Healthcare Provider Details

I. General information

NPI: 1699760306
Provider Name (Legal Business Name): JAMES D WUAMETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 STERTHAUS AVE
ORMOND BEACH FL
32174-5128
US

IV. Provider business mailing address

588 STERTHAUS AVE
ORMOND BEACH FL
32174-5128
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-9501
  • Fax: 386-673-0308
Mailing address:
  • Phone: 386-672-9501
  • Fax: 386-673-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME21427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: