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General NPI Number Information
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NPI Number | 1679770051
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Entity Type | Individual
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Provider Name | JEFFREY P WOLTERS MD, MPH
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Gender | Male
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 4724 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2339
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Country | US
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Telephone | 850-696-4000
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Fax | 850-432-2532
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Provider Business Mailing Address
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Address Line | 4724 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2339
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Country | US
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Telephone | 850-696-4000
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Fax | 850-432-2532
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME114334
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101251366
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License Number State | VA
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