Provider Demographics
NPI:1316002751
Name:WIRES, JOHN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:WIRES
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:3959 PENDER DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6041
Mailing Address - Country:US
Mailing Address - Phone:703-352-3822
Mailing Address - Fax:703-385-8353
Practice Address - Street 1:3959 PENDER DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6041
Practice Address - Country:US
Practice Address - Phone:703-352-3822
Practice Address - Fax:703-385-8353
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA1681103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist