Provider Demographics
NPI:1144311028
Name:WILTZ, JOHN FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANKLIN
Last Name:WILTZ
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:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-525-3334
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:2801 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1713
Practice Address - Country:US
Practice Address - Phone:304-675-4107
Practice Address - Fax:304-697-2086
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18090208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189415Medicaid
1104008481OtherRR MEDICARE
WV0109733000Medicaid
WV0109733000Medicaid
WVWV4567AMedicare PIN
WVG07824Medicare UPIN