Individual
JASON JOHN WIRTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1959 SLOAN PLACE, SUITE 200, ST PAUL, MN 55117-2074
(651) 772-6235
(651) 772-6261
Mailing address
1959 SLOAN PLACE, SUITE 200, ST PAUL, MN 55117-2074
(651) 772-6235
(651) 772-6261
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
44626
MN
207RI0200X
Infectious Disease Physician
Primary
44626
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
324537300
—
MN
Enumeration date
04/27/2006
Last updated
03/11/2021
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