Provider Demographics
NPI:1063447027
Name:WETTER, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:WETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-289-5443
Mailing Address - Fax:704-283-7655
Practice Address - Street 1:1106 REYNOLDS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4375
Practice Address - Country:US
Practice Address - Phone:704-289-5443
Practice Address - Fax:704-283-7655
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986669Medicaid
SCN23097Medicaid
NC211442AMedicare PIN
NC211442BMedicare PIN
NCNC8585AMedicare PIN
NC211442CMedicare PIN
NC8986669Medicaid
NCC87098Medicare UPIN