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General NPI Number Information
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NPI Number | 1982655692
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Entity Type | Individual
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Provider Name | JAMES E WACHTER MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 1006 S DIVISION ST
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City | CARTERVILLE
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State | IL
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Zip | 62918-1539
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Country | US
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Telephone | 618-985-4841
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Fax | 618-985-8101
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Provider Business Mailing Address
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Address Line | PO BOX 577
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City | CARTERVILLE
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State | IL
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Zip | 62918-0577
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Country | US
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Telephone | 618-985-8221
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Fax | 618-985-6860
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036076399
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License Number State | IL
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