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General NPI Number Information
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NPI Number | 1508058710
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Entity Type | Organization
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Legal Business Name | JOHN F WOLZ MD PROF LLC
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Dates
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Enumeration Date | 08/11/2007
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 625 W PLATTE AVE
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City | FORT MORGAN
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State | CO
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Zip | 80701-2669
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Country | US
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Telephone | 970-867-4916
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Fax | 970-867-8659
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Provider Business Mailing Address
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Address Line | PO BOX 799
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City | FORT MORGAN
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State | CO
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Zip | 80701-0799
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Country | US
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Telephone | 970-867-4916
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Fax | 970-867-8659
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LINDA JACKSON
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Credential |
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Telephone | 970-867-4916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | AW424346
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License Number State | CO
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