Healthcare Provider Details

I. General information

NPI: 1205908332
Provider Name (Legal Business Name): JOHN F. WILTZ PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 JACKSON AVE
PT PLEASANT WV
25550-1713
US

IV. Provider business mailing address

2801 JACKSON AVE
PT PLEASANT WV
25550-1713
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4107
  • Fax: 304-675-4233
Mailing address:
  • Phone: 304-675-4107
  • Fax: 304-675-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18090
License Number StateWV

VIII. Authorized Official

Name: DR. JOHN F. WILTZ
Title or Position: DOCTOR
Credential: M.D.
Phone: 304-675-4107