Organization
J ANTHONY WOLTJEN, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN ANTHONY WOLTJEN M.D. (PHYSICIAN)
(816) 220-9080
Entity
Organization
Contact information
Practice address
100 NW MOCK AVE, SUITE 101, BLUE SPRINGS, MO 64014-2501
(816) 220-9080
(816) 220-9010
Mailing address
100 NW MOCK AVE, SUITE 101, BLUE SPRINGS, MO 64014-2501
(816) 220-9080
(816) 220-9010
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R4B13
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008617
PTAN
—
Enumeration date
11/30/2011
Last updated
11/30/2011
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