Individual
JOHN J WIXTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
330 BROOKLINE AVE # SHAPIRO2, BOSTON, MA 02215-5400
(617) 667-3940
Mailing address
PO BOX 415348, BOSTON, MA 02241-0001
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
158390
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2006430
—
MA
Enumeration date
11/09/2005
Last updated
03/16/2018
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