Provider Demographics
NPI:1134133978
Name:WETHE, JAMES D (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:WETHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3440 LOMITA BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4818
Mailing Address - Country:US
Mailing Address - Phone:310-784-8389
Mailing Address - Fax:310-784-8399
Practice Address - Street 1:3440 LOMITA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4818
Practice Address - Country:US
Practice Address - Phone:310-784-8389
Practice Address - Fax:310-784-8399
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAGO467732086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92675Medicare UPIN