Individual
JON P. WAKAMATSU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 747-4577
Mailing address
625 ALBANY AVE, TORRINGTON, WY 82240-1530
(307) 532-2017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5418A
WY
Other
Enumeration date
08/21/2006
Last updated
06/15/2009
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