Provider Demographics
NPI:1467555383
Name:WETMORE, JAMES B (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:WETMORE
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 1:701 PARK AVE
Mailing Address - Street 2:SHAPIRO 5 NEPHROLOGY
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-6988
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:SHAPIRO 5 NEPHROLOGY
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56239207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200330360AMedicaid
MO207471301Medicaid
MO35620014OtherBCBS KC
KS011E050AMedicare ID - Type Unspecified
KSP00251360Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO207471301Medicaid