Provider Demographics
NPI:1568423192
Name:WOLLNER, JOHN HUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HUGH
Last Name:WOLLNER
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 1:716 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1916
Mailing Address - Country:US
Mailing Address - Phone:319-363-9936
Mailing Address - Fax:319-363-0520
Practice Address - Street 1:5264 COUNCIL ST NE STE 700
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2477
Practice Address - Country:US
Practice Address - Phone:319-363-9936
Practice Address - Fax:319-363-0520
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25852174400000X
IAMD-25852207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24580OtherWELLMARK BCBS
IA0245803Medicaid
IA24580OtherWELLMARK BCBS
IA24580Medicare ID - Type Unspecified