Provider Demographics
NPI:1598055477
Name:WIPRUT, JAMES (HIS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WIPRUT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 LYNN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-6855
Mailing Address - Country:US
Mailing Address - Phone:828-859-3007
Mailing Address - Fax:828-859-3011
Practice Address - Street 1:2753 LYNN RD
Practice Address - Street 2:SUITE D
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-6855
Practice Address - Country:US
Practice Address - Phone:828-859-3007
Practice Address - Fax:828-859-3011
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC679A01237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist