Individual
JAY EDWARD WOLVERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 UNIVERSITY BLVD # UH3240, INDIANAPOLIS, IN 46202-5149
(317) 630-6833
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01081469A
IN
207N00000X
Dermatology Physician
MD189143
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/02/2013
Last updated
11/25/2020
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