Healthcare Provider Details

I. General information

NPI: 1699002196
Provider Name (Legal Business Name): JEFFREY SCOTT WUNNING D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 RIFFEL RD STE A
WOOSTER OH
44691-8592
US

IV. Provider business mailing address

365 RIFFEL RD STE A
WOOSTER OH
44691-8592
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-5500
  • Fax: 330-345-7793
Mailing address:
  • Phone: 330-345-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016.005449
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number003661
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number003661
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number003661
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: