Individual
JONATHAN WOLKWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
116 E. 2ND, DEXTER, NM 88230
(575) 734-5817
(575) 734-6550
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
96-PA22
NM
363A00000X
Physician Assistant
Primary
96-PA22
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79336213
—
NM
Enumeration date
09/30/2005
Last updated
09/15/2020
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