Healthcare Provider Details

I. General information

NPI: 1669544151
Provider Name (Legal Business Name): JOHN WILLIAM WOLTZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N ARNOLD RD STE 102
PANAMA CITY BEACH FL
32413-2291
US

IV. Provider business mailing address

651 GRAND PANAMA BLVD BLDG B-2
PANAMA CITY BEACH FL
32407-3458
US

V. Phone/Fax

Practice location:
  • Phone: 850-234-3087
  • Fax:
Mailing address:
  • Phone: 850-234-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOS16249
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: