Healthcare Provider Details

I. General information

NPI: 1619995420
Provider Name (Legal Business Name): JAMES P WASEMILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 ST FRANCIS DR
BRECKENRIDGE MN
56520-1025
US

IV. Provider business mailing address

614 DAKOTA AVE
WAHPETON ND
58075-4300
US

V. Phone/Fax

Practice location:
  • Phone: 218-643-3000
  • Fax: 218-643-7502
Mailing address:
  • Phone: 701-642-4471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22972
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number12647
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: