Healthcare Provider Details

I. General information

NPI: 1366522815
Provider Name (Legal Business Name): JASON P WILTSHIRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1197
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1197
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax: 620-669-2501
Mailing address:
  • Phone: 620-669-2500
  • Fax: 620-669-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number04-33922
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: