Individual
BRYAN JACOB WOHLFELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
719 W 2ND ST, BLOOMINGTON, IN 47403-2209
(812) 676-4730
(812) 676-4731
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
(214) 645-2300
(214) 645-2301
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
01084250A
IN
207T00000X
Neurological Surgery Physician
N7764
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297763901
—
TX
01
—
TXB134441
MEDICARE PTAN
TX
Enumeration date
06/05/2007
Last updated
08/19/2020
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