Individual
MR. JEROME PAUL WOLLFARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
340 FALCONER DR, COVINGTON, LA 70433
(985) 893-2845
(985) 893-2654
Mailing address
22056 SPRING CLOVER LN, COVINGTON, LA 70435-6738
(985) 893-2845
(985) 893-2654
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06427
LA
Other
Enumeration date
11/13/2006
Last updated
11/20/2007
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