Provider Demographics
NPI:1902809114
Name:WOLPER, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:WOLPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2009
Mailing Address - Country:US
Mailing Address - Phone:239-826-7800
Mailing Address - Fax:
Practice Address - Street 1:11351 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325
Practice Address - Country:US
Practice Address - Phone:239-826-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-02-11
Deactivation Date:2010-04-21
Deactivation Code:
Reactivation Date:2010-11-03
Provider Licenses
StateLicense IDTaxonomies
FLME42832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2499167OtherGHI
FL36364OtherBCBS
FL86389440OtherTRICARE
FLP00100578OtherRAILROAD MEDICARE
FL4091450OtherAETNA
FL204153OtherAVMED
FL068492900Medicaid
FL2499167OtherGHI
FL86389440OtherTRICARE